Provider Demographics
NPI:1023428877
Name:HASSAN, AMMAR (DO)
Entity type:Individual
Prefix:
First Name:AMMAR
Middle Name:
Last Name:HASSAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9410 CALUMET AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-0018
Mailing Address - Country:US
Mailing Address - Phone:219-922-4900
Mailing Address - Fax:219-836-9922
Practice Address - Street 1:9410 CALUMET AVE STE 401
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-0018
Practice Address - Country:US
Practice Address - Phone:219-922-4900
Practice Address - Fax:219-836-9922
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005989A207R00000X
IL390200000X
IN2005989A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program