Provider Demographics
NPI:1811994288
Name:HANNA, MICHEL MOUSSA (MD)
Entity type:Individual
Prefix:
First Name:MICHEL
Middle Name:MOUSSA
Last Name:HANNA
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 1:5651 BELMONT CIR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1435
Mailing Address - Country:US
Mailing Address - Phone:248-592-9897
Mailing Address - Fax:
Practice Address - Street 1:1701 SOUTH BLVD E
Practice Address - Street 2:SUITE 160
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6122
Practice Address - Country:US
Practice Address - Phone:586-726-0340
Practice Address - Fax:586-254-3872
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065244207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP27310001Medicare PIN
MIG94133Medicare UPIN