Provider Demographics
NPI:1184993404
Name:HASAN HASABA MD PLLC
Entity type:Organization
Organization Name:HASAN HASABA MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HASAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HASABA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-559-7958
Mailing Address - Street 1:15990 W 9 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4826
Mailing Address - Country:US
Mailing Address - Phone:248-559-7958
Mailing Address - Fax:
Practice Address - Street 1:15990 W 9 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4826
Practice Address - Country:US
Practice Address - Phone:248-559-7958
Practice Address - Fax:248-559-0908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty