Individual
ANDRE P BOUHASIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1151 HAZEL LN, FARMINGTON, MO 63640-1920
(573) 705-7870
Mailing address
1151 HAZEL LN, FARMINGTON, MO 63640-1920
(573) 701-0090
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
2004002409
MO
207RI0011X
Interventional Cardiology Physician
Primary
2004002409
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
124884
BLUE CROSS
MO
05
—
206138802
—
MO
01
—
426403
HEALTHLINK
MO
01
—
947071631
MERCY HEALTH
MO
Enumeration date
06/12/2006
Last updated
12/03/2025
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