Provider Demographics
NPI:1619909991
Name:HASAN, SYED MAHMOOD (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:MAHMOOD
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 1:6626 E 75TH STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-621-7561
Mailing Address - Fax:317-355-6096
Practice Address - Street 1:7165 CLEARVISTA WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4621
Practice Address - Country:US
Practice Address - Phone:317-621-5100
Practice Address - Fax:317-621-7896
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057120A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000653878OtherANTHEM
NM71255583Medicaid
INP01191764OtherRR MEDICARE PTAN
IN000000721882OtherANTHEM
IN244724OtherVALUE OPTIONS
IN200858960Medicaid
IN284745OtherMANAGED HEALTH NETWORK
IN000000983429OtherANTHEM PIN
IN266180074Medicare PIN
ININ2762046Medicare PIN
ININ2504002Medicare PIN
INM400015664Medicare PIN
NM341405503Medicare PIN
IN940430Medicare PIN
IN363920Medicare PIN
IN244724OtherVALUE OPTIONS
NM71255583Medicaid