Provider Demographics
NPI:1558332783
Name:HASABA, HASAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HASAN
Middle Name:
Last Name:HASABA
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 1:15990 W 9 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4826
Mailing Address - Country:US
Mailing Address - Phone:248-559-7958
Mailing Address - Fax:248-559-9080
Practice Address - Street 1:15990 W 9 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4826
Practice Address - Country:US
Practice Address - Phone:248-559-7958
Practice Address - Fax:248-559-9080
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2024-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHH024030208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics