MEDICARE: DR. EIHAB OMAR HASSANEIN 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	207R00000X	Internal Medicine Physician	ME67539	FL

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	:	1063619153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EIHAB OMAR HASSANEIN MD

Provider Business Mailing Address
First Line	:	2702 MCGREGOR BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-5920
Country	:	US
Telephone Number	:	850-810-5306
Fax Number	:	850-810-5306

Provider Business Practice Location Address
First Line	:	1400 COLONIAL BLVD
Second Line	:	SUITE 203
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1055
Country	:	US
Telephone Number	:	239-938-9184
Fax Number	:	239-938-9184

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

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	12/05/2016

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