Provider Demographics
NPI:1881687861
Name:ISMAIL, HASSAN M (MD)
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:M
Last Name:ISMAIL
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 1:4160 JOHN R ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2020
Mailing Address - Country:US
Mailing Address - Phone:313-993-7777
Mailing Address - Fax:313-993-2563
Practice Address - Street 1:4160 JOHN R ST
Practice Address - Street 2:SUITE 510
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2020
Practice Address - Country:US
Practice Address - Phone:313-993-7777
Practice Address - Fax:313-993-2563
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD34090207R00000X
MI4301075612207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00717Medicare UPIN
TN3872064Medicare ID - Type Unspecified