Provider Demographics
NPI:1093008229
Name:HASSAN A HAMMOUD MD PC
Entity Type:Organization
Organization Name:HASSAN A HAMMOUD MD PC
Other - Org Name:ADVANCED ORTHOPEDIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-581-5111
Mailing Address - Street 1:4945 SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3251
Mailing Address - Country:US
Mailing Address - Phone:313-581-5111
Mailing Address - Fax:313-581-4640
Practice Address - Street 1:4945 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3251
Practice Address - Country:US
Practice Address - Phone:313-581-5111
Practice Address - Fax:313-581-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4521356Medicaid
MI2008203382OtherBCBS OF MICHIGAN
MI4521356Medicaid