Provider Demographics
NPI:1447294780
Name:HAMDAN, MOHAMMED S (PT)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:S
Last Name:HAMDAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 W GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2042
Mailing Address - Country:US
Mailing Address - Phone:414-352-3100
Mailing Address - Fax:
Practice Address - Street 1:4848 S 76TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4361
Practice Address - Country:US
Practice Address - Phone:414-282-5610
Practice Address - Fax:414-282-8221
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10427-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36112300Medicaid
WIP00627709OtherRR MEDICARE
WI01994-0357Medicare PIN
WIP00627709OtherRR MEDICARE