MEDICARE: HASAN M. MOUSLI 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	2084N0400X	Neurology Physician	ME97722	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
2	92669	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710984679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HASAN M. MOUSLI MD

Provider Business Mailing Address
First Line	:	1120 CARLTON AVE
Second Line	:	SUITE 1300
City	:	LAKE WALES
State	:	FL
Zip	:	33853-4348
Country	:	US
Telephone Number	:	863-676-6386
Fax Number	:	863-676-6452

Provider Business Practice Location Address
First Line	:	1120 CARLTON AVE
Second Line	:	SUITE 1300
City	:	LAKE WALES
State	:	FL
Zip	:	33853-4348
Country	:	US
Telephone Number	:	863-676-6386
Fax Number	:	863-676-6452

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

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	09/20/2012

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