Provider Demographics
NPI:1457668139
Name:ELHEWAN, HASSAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:A
Last Name:ELHEWAN
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 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-1771
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:8885 STATE ROAD 237
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-8567
Practice Address - Country:US
Practice Address - Phone:812-547-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA79569207Q00000X
PAMD454459207Q00000X, 207Q00000X
FLME115741208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009206000Medicaid
FLP01544963OtherRRMR
FLHL697YOtherMEDICARE
FLHL697XMedicare PIN