Provider Demographics
NPI:1003885500
Name:HANNA, MOUSA MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:MOUSA
Middle Name:MICHAEL
Last Name:HANNA
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1411 N FLAGLER DR
Mailing Address - Street 2:SUITE 6300
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3404
Mailing Address - Country:US
Mailing Address - Phone:561-659-6023
Mailing Address - Fax:561-659-6025
Practice Address - Street 1:1411 N FLAGLER DR
Practice Address - Street 2:SUITE 6300
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3404
Practice Address - Country:US
Practice Address - Phone:561-659-6023
Practice Address - Fax:561-659-6025
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2016-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL6942207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57152AMedicare PIN