MEDICARE: DR. ALI A M HASSOUN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	25943	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063404978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALI A M HASSOUN MD

Provider Business Mailing Address
First Line	:	420 LOWELL DR SE
Second Line	:	SUITE 301
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-3754
Country	:	US
Telephone Number	:	256-265-7955
Fax Number	:	256-265-7954

Provider Business Practice Location Address
First Line	:	420 LOWELL DR SE
Second Line	:	SUITE 301
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-3754
Country	:	US
Telephone Number	:	256-265-7955
Fax Number	:	256-265-7954

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	10/10/2012

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