Active NPI
Alfatah Muhudin Hassan
- Intermediate Emergency Medical Technician
- Cudahy, WI
National Provider Identifier
1164173605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intermediate Emergency Medical Technician
- License
- H2500139810006
- Practice address
- 5515 S Disch Ave Apt 2
Cudahy, WI 53110-2630 - Phone
- (414) 334-3341
- NPI assigned
- Jan 17, 2022
- Reactivated
- Aug 31, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intermediate Emergency Medical Technician | 146M00000X | H2500139810006 | WI | Primary |
Addresses
Primary practice location
5515 S Disch Ave Apt 2
Cudahy, WI 53110-2630
Mailing address
5515 S Disch Ave Apt 2
Cudahy, WI 53110-2630
Phone (414) 334-3341
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 87-4381953 | Other | WI | NON EMERGENCY MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H2500139810006 | WI | MD | Intermediate Emergency Medical Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693440000000",
"number": "1164173605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5515 S DISCH AVE APT 2",
"city": "CUDAHY",
"state": "WI",
"postal_code": "531102630",
"telephone_number": "414-334-3341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5515 S DISCH AVE APT 2",
"city": "CUDAHY",
"state": "WI",
"postal_code": "531102630",
"telephone_number": "414-334-3341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HASSAN",
"first_name": "ALFATAH",
"middle_name": "MUHUDIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-01-17",
"last_updated": "2023-08-31",
"certification_date": "2022-07-09",
"deactivation_date": "2022-07-09",
"reactivation_date": "2023-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "146M00000X",
"taxonomy_group": "",
"desc": "Emergency Medical Technician, Intermediate",
"state": "WI",
"license": "H2500139810006",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NON EMERGENCY MEDICARE",
"identifier": "87-4381953",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cudahy, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.