Basic Information
| Provider Information | |||||||||
| NPI: | 1780171033 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HASSAN | ||||||||
| FirstName: | WALEED | ||||||||
| MiddleName: | AHMED KHALAF | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 956 COURT AVE STE H314 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381032814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014482510 | ||||||||
| FaxNumber: | 9014487836 | ||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY OF TENNESSEE 920 MADISON AVENUE SUITE 447 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381630001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014487836 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2018 | ||||||||
| LastUpdateDate: | 10/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | 193400000X SINGLE SPECIALTY GROUP | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | T-4354 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.