Basic Information
| Provider Information | |||||||||
| NPI: | 1790807675 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DBOUK | ||||||||
| FirstName: | HASSAN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5005 W DAUBER DR | ||||||||
| Address2: | |||||||||
| City: | OTTAWA HILLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436152173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0598758653 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 CHILDRENS PLZ | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454041815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376414000 | ||||||||
| FaxNumber: | 9376416492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 10/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0203X | 28846 | WV | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | 2080P0214X | ME120102 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | 208M00000X | 35-076143 | OH | N | Allopathic & Osteopathic Physicians | Hospitalist | 2080S0012X | 35.076143 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics | Sleep Medicine | 2080P0214X | 26020 | OK | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology |
ID Information
| ID | Type | State | Issuer | Description | 0165083 | 05 | OH | MEDICAID |