Provider Demographics
NPI:1992708465
Name:HASNAIN, MOHAMMED K (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:K
Last Name:HASNAIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:207 SPARKS AVE STE 300
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3739
Practice Address - Country:US
Practice Address - Phone:812-218-7978
Practice Address - Fax:812-218-6589
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057455A174400000X, 2084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No174400000XOther Service ProvidersSpecialist
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100236450Medicaid
IN200430120Medicaid
IN01057455AOtherSTATE LICENSE
KY44372OtherSTATE LICENSE