Provider Demographics
NPI:1598466344
Name:HASAN, SAZID MOHAMMED
Entity Type:Individual
Prefix:
First Name:SAZID
Middle Name:MOHAMMED
Last Name:HASAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2974 SQUIRE CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-6211
Mailing Address - Country:US
Mailing Address - Phone:248-759-3760
Mailing Address - Fax:
Practice Address - Street 1:2974 SQUIRE CT
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-6211
Practice Address - Country:US
Practice Address - Phone:248-759-3760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program