Provider Demographics
NPI:1881687507
Name:HASSAN, SYED K (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:K
Last Name:HASSAN
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 1:3005 CARING WAY
Mailing Address - Street 2:UNITS 2 NS 3
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5304
Mailing Address - Country:US
Mailing Address - Phone:941-249-8493
Mailing Address - Fax:941-249-8537
Practice Address - Street 1:3005 CARING WAY
Practice Address - Street 2:UNITS 2 AND 3
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5304
Practice Address - Country:US
Practice Address - Phone:941-249-8493
Practice Address - Fax:941-249-8537
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-28
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251108800Medicaid
FL32408OtherBCBS
FL292260OtherWELLCARE
FL5291720OtherAETNA
FL32408OtherBCBS
FL292260OtherWELLCARE
FL110226959Medicare PIN