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General NPI Number Information
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NPI Number | 1609425180
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Entity Type | Organization
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Legal Business Name | WAFA A ELHASSAN MD PLLC
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Dates
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Enumeration Date | 09/08/2019
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 4020 VENOY RD STE 300
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City | WAYNE
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State | MI
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Zip | 48184-1899
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Country | US
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Telephone | 734-589-1090
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Fax | 734-589-1091
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Provider Business Mailing Address
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Address Line | 39466 DORCHESTER CIR
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City | CANTON
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State | MI
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Zip | 48188-5000
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | DIANA EL MASRI
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Credential |
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Telephone | 248-215-0048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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