Provider Demographics
NPI:1194768432
Name:MOOSA, HANS HASSAN (MD)
Entity type:Individual
Prefix:DR
First Name:HANS
Middle Name:HASSAN
Last Name:MOOSA
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 1:4600 MEMORIAL DR STE 160
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5359
Mailing Address - Country:US
Mailing Address - Phone:618-825-9272
Mailing Address - Fax:618-222-1039
Practice Address - Street 1:4600 MEMORIAL DR STE 160
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5359
Practice Address - Country:US
Practice Address - Phone:618-825-9272
Practice Address - Fax:618-222-1039
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0732502086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036073250Medicaid
IL036073250Medicaid
ILIL3521002Medicare PIN