| Wafa A Elhassan Md Pllc | |
|
4020 Venoy Rd Ste 300 Wayne MI 48184-1899 | |
| (734) 589-1090 | |
| (734) 589-1091 |
| Full Name | Wafa A Elhassan Md Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4020 Venoy Rd Ste 300, Wayne, Michigan |
| Authorized Official Name and Position | Diana El Masri (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2482150048 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wafa A Elhassan Md Pllc 39466 Dorchester Cir Canton MI 48188-5000 Ph: () - | Wafa A Elhassan Md Pllc 4020 Venoy Rd Ste 300 Wayne MI 48184-1899 Ph: (734) 589-1090 |
| NPI Number | 1609425180 |
|---|---|
| Provider Enumeration Date | 09/08/2019 |
| Last Update Date | 04/10/2023 |
| Medicare PECOS PAC ID | 5799119301 |
|---|---|
| Medicare Enrollment ID | O20200107000418 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609425180 | NPI | - | NPPES |
| 1699115535 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Abdulla A Hafeez |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1265663751 PECOS PAC ID: 6901056597 Enrollment ID: I20121018000367 |
| Provider Name | Wafa A Elhassan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699115535 PECOS PAC ID: 8022377878 Enrollment ID: I20180124000733 |
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