Provider Demographics
NPI:1891080883
Name:HASAN, SYED MUSTAFA (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:MUSTAFA
Last Name:HASAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MUSTAFA
Other - Middle Name:
Other - Last Name:HASAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:300 S BRUCE ST
Mailing Address - Street 2:AVERA MARSHALL
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-1934
Mailing Address - Country:US
Mailing Address - Phone:507-537-9300
Mailing Address - Fax:507-537-9356
Practice Address - Street 1:1100 MERCER AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733-2303
Practice Address - Country:US
Practice Address - Phone:260-724-2145
Practice Address - Fax:260-728-3852
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN58354207P00000X
IN01072973A207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine