Provider Demographics
NPI:1043287436
Name:HASSAN, MUSHIR (MD)
Entity type:Individual
Prefix:DR
First Name:MUSHIR
Middle Name:
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 1:17000 W NORTH AVE
Mailing Address - Street 2:SUITE 200 E
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4423
Mailing Address - Country:US
Mailing Address - Phone:262-782-4270
Mailing Address - Fax:262-784-9319
Practice Address - Street 1:17000 W NORTH AVE
Practice Address - Street 2:SUITE 200 E
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4423
Practice Address - Country:US
Practice Address - Phone:262-782-4270
Practice Address - Fax:262-784-9319
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40948207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32535400Medicaid
WI685450016Medicare ID - Type Unspecified
WIG70888Medicare UPIN