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General NPI Number Information
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NPI Number | 1194768432
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Entity Type | Individual
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Provider Name | HANS HASSAN MOOSA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 4600 MEMORIAL DR STE 120
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City | BELLEVILLE
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State | IL
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Zip | 62226-5359
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Country | US
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Telephone | 618-825-9272
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Fax | 618-222-1039
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Provider Business Mailing Address
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Address Line | 4600 MEMORIAL DR STE 160
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City | BELLEVILLE
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State | IL
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Zip | 62226-5359
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Country | US
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Telephone | 618-825-9272
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Fax | 618-222-1039
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 036-073250
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License Number State | IL
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