MEDICARE: DR. REWA MAHMOUD HASANAT M.D.

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	207Q00000X	Family Medicine Physician	036131285	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	231199026	OTHER	IL	MEDICARE

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
3	P01148828	OTHER	IL	RRM

General Provider Information

NPI Number	:	1457582926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REWA MAHMOUD HASANAT M.D.

Provider Business Mailing Address
First Line	:	27702 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1277
Country	:	US
Telephone Number	:	708-862-7674
Fax Number	:	708-862-1781

Provider Business Practice Location Address
First Line	:	15300 WEST AVE STE 20
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-4504
Country	:	US
Telephone Number	:	708-460-5550
Fax Number	:	708-226-2595

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

Provider Enumeration Date	:	08/01/2009
Last Update Date	:	03/28/2023

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Directions to “ DR. REWA MAHMOUD HASANAT M.D.” Practice Location

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