Provider Demographics
NPI:1376771626
Name:NASIR, HASSAN M (DO)
Entity Type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:M
Last Name:NASIR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 E NEWLAND DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3051
Mailing Address - Country:US
Mailing Address - Phone:248-890-8711
Mailing Address - Fax:
Practice Address - Street 1:575 COURT ST STE 3
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9387
Practice Address - Country:US
Practice Address - Phone:989-701-2159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36135769207K00000X
MI5101018446207R00000X, 207RR0500X, 207K00000X
FLOS11877207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400149936Medicare PIN