Provider Demographics
NPI:1396361432
Name:SOUIDAN, HASSAN (MD)
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:
Last Name:SOUIDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 ST ANTOINE STREET
Mailing Address - Street 2:UNIVERSITY HEALTH CENTER - UHC 8C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-745-1302
Mailing Address - Fax:
Practice Address - Street 1:4201 ST ANTOINE STREET
Practice Address - Street 2:UNIVERSITY HEALTH CENTER - UHC 8C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-1302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2022-05-24
Deactivation Date:2022-01-17
Deactivation Code:
Reactivation Date:2022-05-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program