Provider Demographics
NPI:1063619153
Name:HASSANEIN, EIHAB OMAR (MD)
Entity type:Individual
Prefix:DR
First Name:EIHAB
Middle Name:OMAR
Last Name:HASSANEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2702 MCGREGOR BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-5920
Mailing Address - Country:US
Mailing Address - Phone:850-810-5306
Mailing Address - Fax:850-810-5306
Practice Address - Street 1:1400 COLONIAL BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1055
Practice Address - Country:US
Practice Address - Phone:239-938-9184
Practice Address - Fax:239-938-9184
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67539207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F87096Medicare UPIN