Provider Demographics
NPI:1417996067
Name:HASAN, SHAHZAD (MD)
Entity Type:Individual
Prefix:
First Name:SHAHZAD
Middle Name:
Last Name:HASAN
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:PO BOX 53568
Mailing Address - Street 2:SUN HEALTH CLINICS & PHYSICIAN SERVICES
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85072-3568
Mailing Address - Country:US
Mailing Address - Phone:623-544-5070
Mailing Address - Fax:
Practice Address - Street 1:10401 W THUNDERBIRD BLVD
Practice Address - Street 2:SUITE M434
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3004
Practice Address - Country:US
Practice Address - Phone:623-876-5622
Practice Address - Fax:623-815-2391
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33716207R00000X
CO43205207R00000X
NM98-71207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ764234Medicaid
F88769Medicare UPIN
AZ764234Medicaid
AZ104143Medicare PIN