MEDICARE: HASSANEIN CLINIC INC

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	ME68679	FL

General Provider Information

NPI Number	:	1790773968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HASSANEIN CLINIC INC

Provider Business Mailing Address
First Line	:	1607 NW FEDERAL HWY
Second Line	:	SUITE B
City	:	STUART
State	:	FL
Zip	:	34994-9600
Country	:	US
Telephone Number	:	772-692-8082
Fax Number	:	772-232-9383

Provider Business Practice Location Address
First Line	:	1607 NW FEDERAL HWY
Second Line	:	SUITE B
City	:	STUART
State	:	FL
Zip	:	34994-9600
Country	:	US
Telephone Number	:	772-692-8082
Fax Number	:	772-232-9383

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HOSSAM M HASSANEIN
Credential	:	M.D.
Telephone Number	:	772-692-8082

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	08/22/2020

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