Provider Demographics
NPI:1477561140
Name:HASSAN, ADAM S (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:S
Last Name:HASSAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2757 LEONARD ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-5807
Mailing Address - Country:US
Mailing Address - Phone:616-942-6687
Mailing Address - Fax:616-942-9797
Practice Address - Street 1:2757 LEONARD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-5807
Practice Address - Country:US
Practice Address - Phone:616-942-6687
Practice Address - Fax:616-942-9797
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301072672207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H70762Medicare UPIN
P07970002Medicare PIN