Provider Demographics
NPI:1801393566
Name:HASAN, TASNEEM FATEMA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:TASNEEM
Middle Name:FATEMA
Last Name:HASAN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 DAVIS LAKE RD STE A
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1485
Mailing Address - Country:US
Mailing Address - Phone:810-660-8477
Mailing Address - Fax:
Practice Address - Street 1:237 DAVIS LAKE RD STE A
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1485
Practice Address - Country:US
Practice Address - Phone:810-660-8477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-172922084N0400X
MI43015059592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology