Individual ProviderHazar HassunehInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address530 S Jackson St, Louisville, KY 40202-1675(502) 852-7041PECOS EnrollmentBased on the most recent information from CMS, provider Hazar Hassuneh is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1649634544Provider TypeIndividualFull NameHassuneh, HazarCredentialMDGenderFemaleSole ProprietorNoEnumeration Date4/7/2016Last Updated3/1/2021Contact InformationPractice LocationPractice Address530 S Jackson St, Louisville, KY 40202-1675Phone(502) 852-7041Fax(502) 589-5093Mailing LocationMailing AddressPO Box 909, Louisville, KY 40201-0909Phone(502) 852-7041Fax(502) 589-5093Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense54079KentuckyCode208000000XDescriptionPediatricsAllopathic & Osteopathic PhysiciansLicense54079KentuckyCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID7100483170DescriptionMedicaidIssuerUnlistedKentucky