Provider Demographics
NPI:1891705745
Name:HASSUNIZADEH, BISCHAN (MD)
Entity Type:Individual
Prefix:MR
First Name:BISCHAN
Middle Name:
Last Name:HASSUNIZADEH
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 1:2271 CHARTER DR
Mailing Address - Street 2:APT 106
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083
Mailing Address - Country:US
Mailing Address - Phone:248-619-7465
Mailing Address - Fax:
Practice Address - Street 1:205 PAGE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201
Practice Address - Country:US
Practice Address - Phone:517-787-3577
Practice Address - Fax:517-787-4280
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080801174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist