Provider Demographics
NPI:1669532065
Name:HASSAN, AHMED A (MD)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:A
Last Name:HASSAN
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-1449
Mailing Address - Fax:239-424-1421
Practice Address - Street 1:8960 COLONIAL CENTER DR
Practice Address - Street 2:SUITE 206
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7809
Practice Address - Country:US
Practice Address - Phone:239-343-9560
Practice Address - Fax:239-343-9624
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032214207QG0300X
FLME0030650207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI322340210Medicaid
AH032214OtherCHAMPUS-CHAMPUS
080H262390OtherBLUE CROSS-BLUE CROSS
AH032214OtherCOMMERCIAL-COMMERCIAL NUMBER
B43552Medicare UPIN
080H262390OtherBLUE CROSS-BLUE CROSS