Provider Demographics
NPI:1063404978
Name:HASSOUN, ALI A M (MD)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:A M
Last Name:HASSOUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:420 LOWELL DR SE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3754
Mailing Address - Country:US
Mailing Address - Phone:256-265-7955
Mailing Address - Fax:256-265-7954
Practice Address - Street 1:420 LOWELL DR SE
Practice Address - Street 2:SUITE 301
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3754
Practice Address - Country:US
Practice Address - Phone:256-265-7955
Practice Address - Fax:256-265-7954
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL25943207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009970955Medicaid
ALI22022Medicare UPIN