Provider Demographics
NPI:1063488526
Name:MOUSSA, HALLA S (MD)
Entity Type:Individual
Prefix:
First Name:HALLA
Middle Name:S
Last Name:MOUSSA
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:8929 PARALLEL PKWY
Mailing Address - Street 2:ATTN: PMG PHYSICIAN CREDENTIALING KATHLEEN
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-1689
Mailing Address - Country:US
Mailing Address - Phone:913-596-3893
Mailing Address - Fax:913-299-4205
Practice Address - Street 1:1150 N 75TH PL
Practice Address - Street 2:SUITE 200
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-2430
Practice Address - Country:US
Practice Address - Phone:913-299-2100
Practice Address - Fax:913-299-4205
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2016-04-08
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Provider Licenses
StateLicense IDTaxonomies
KS0425523207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSF99345Medicare UPIN
KS100171150CMedicaid
KS100171150DMedicaid
MOC478464Medicare ID - Type Unspecified
KSF99345Medicare UPIN