Provider Demographics
NPI:1710973821
Name:FHASAN, HASAN SULEIMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HASAN
Middle Name:SULEIMAN
Last Name:FHASAN
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 1:8275 N WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1143
Mailing Address - Country:US
Mailing Address - Phone:248-476-8600
Mailing Address - Fax:734-728-4810
Practice Address - Street 1:8275 N WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1143
Practice Address - Country:US
Practice Address - Phone:248-476-8600
Practice Address - Fax:734-728-4810
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085291207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI29490001Medicaid
MII44144Medicare UPIN
MIMI29490001Medicaid