Provider Demographics
NPI:1689361669
Name:HASAN, HEMICA BINTE (MBBS)
Entity Type:Individual
Prefix:
First Name:HEMICA
Middle Name:BINTE
Last Name:HASAN
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TRINITY HEALTH LIVONIA HOSPITAL
Mailing Address - Street 2:36475 FIVE MILE ROAD
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154
Mailing Address - Country:US
Mailing Address - Phone:734-655-2727
Mailing Address - Fax:734-655-8430
Practice Address - Street 1:TRINITY HEALTH ACADEMIC INTERNAL MEDICINE-NORTHWEST
Practice Address - Street 2:37595 FIVE MILE ROAD, SUITE 340
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:734-793-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-12-01
Deactivation Date:2023-11-22
Deactivation Code:
Reactivation Date:2023-12-01
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program