Provider Demographics
NPI:1730140781
Name:ALHASSEN, MOHAMMED A (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:A
Last Name:ALHASSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2240
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85299-2240
Mailing Address - Country:US
Mailing Address - Phone:877-347-1557
Mailing Address - Fax:480-588-7976
Practice Address - Street 1:3411 E LARK DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5652
Practice Address - Country:US
Practice Address - Phone:877-347-1557
Practice Address - Fax:480-588-7976
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31715207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ786543Medicaid
AZZ75859Medicare ID - Type Unspecified
AZZ114309Medicare PIN
AZH92111Medicare UPIN