Provider Demographics
NPI:1174511679
Name:HASSAN, MOHAMED (MHS,PT)
Entity Type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:
Last Name:HASSAN
Suffix:
Gender:M
Credentials:MHS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 VILLAGE CENTER DR
Mailing Address - Street 2:STE 205
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-4526
Mailing Address - Country:US
Mailing Address - Phone:815-876-7063
Mailing Address - Fax:630-920-4687
Practice Address - Street 1:3900 W 95TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805
Practice Address - Country:US
Practice Address - Phone:708-423-7900
Practice Address - Fax:708-423-7999
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200472150Medicaid
ILL97286Medicare ID - Type UnspecifiedDUPAGE COUNTY
IN247620AMedicare ID - Type Unspecified
IL650020872Medicare ID - Type UnspecifiedRAILROAD
ILP00020059Medicare ID - Type UnspecifiedRAILROAD DUPAGE COUNTY
ILL82881Medicare ID - Type UnspecifiedCOOK COUNTY