Provider Demographics
NPI:1770579567
Name:HASAN, TARIK K (MD)
Entity type:Individual
Prefix:
First Name:TARIK
Middle Name:K
Last Name:HASAN
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 1:1082 E BRANDON BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5509
Mailing Address - Country:US
Mailing Address - Phone:813-689-9900
Mailing Address - Fax:813-653-9696
Practice Address - Street 1:1082 E BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5509
Practice Address - Country:US
Practice Address - Phone:813-689-9900
Practice Address - Fax:813-653-9696
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2024-02-08
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
FLME69066174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378585800Medicaid
FLF70871Medicare UPIN
F70871Medicare UPIN
FL27563TMedicare PIN