Provider Demographics
NPI:1558626564
Name:HASAN, OMAR (DO)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:HASAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7697 BEECHMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-4216
Mailing Address - Country:US
Mailing Address - Phone:513-624-3600
Mailing Address - Fax:513-624-3605
Practice Address - Street 1:5145 N CALIFORNIA AVE
Practice Address - Street 2:SWEDISH COVENANT HOSPITAL - MEDICAL EDUCATION DEPT
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625
Practice Address - Country:US
Practice Address - Phone:773-878-8200
Practice Address - Fax:773-989-1648
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.137644207R00000X, 208M00000X
OH34.013209207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist