Wafa a Elhassan MD PLLC

Primary specialty

Integrative Medicine PhysicianTaxonomy code 202D00000X

Legal business name

WAFA A ELHASSAN MD PLLC

Practice address

4020 Venoy Rd Ste 300
Wayne, MI 48184-1899

Phone

(734) 589-1090

Fax

(734) 589-1091

NPI assigned

Sep 8, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Diana El Masri

Title

Credentialing Coordinator

Phone

(248) 215-0048

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wafa Elhassan, MD

  • Internal Medicine Physician
  • Dearborn, MI
  • NPI 1699115535

  MI

  Medicare reassignment Care Compare group NPD
• Abdulla Abdel Hafeez

  • Geriatric Medicine (Internal Medicine) Physician
  • Dearborn, MI
  • NPI 1265663751

  MI

  Medicare reassignment Care Compare group NPD
• Leah Marie London, NP

  • Nurse Practitioner
  • Southfield, MI
  • NPI 1043736226

  MI

  Medicare reassignment NPD
• Luningning V Regalado, M.D.

  • Internal Medicine Physician
  • Wayne, MI
  • NPI 1801969472
  NPD
• Normita Davila Vicencio, MD

  • Internal Medicine Physician
  • Wayne, MI
  • NPI 1700973385
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1567900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738108800000",
    "number": "1609425180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39466 DORCHESTER CIR",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481885000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 VENOY RD STE 300",
            "city": "WAYNE",
            "state": "MI",
            "postal_code": "481841899",
            "telephone_number": "734-589-1090",
            "fax_number": "734-589-1091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAFA A ELHASSAN MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-08",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A",
        "authorized_official_last_name": "EL MASRI",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "248-215-0048"
    },
    "taxonomies": [
        {
            "code": "202D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Integrative Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1699115535",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "diana@embpm.com",
            "affiliation": "N",
            "address_1": "39466 Dorchester Cir",
            "city": "Canton",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481885000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Puthenparampil G Vijayakumaran, MD
• Vishnu Pemmaraju, MD
• Shawna Viskantas
• Vonnies World Non-Profit Organization
• Ashim Wadehra, DPM
• Sean S Walcott, MD
• Tinalouise Jean Wales
• Walgreen Co
• Rachel Walker
• Raven Walker

• Integrative Medicine Physician in Wayne, MI
• Providers in Wayne, MI by specialty
• Integrative Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.