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 1:9725 NW 117TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1260
Mailing Address - Country:US
Mailing Address - Phone:954-432-0578
Mailing Address - Fax:954-432-5060
Practice Address - Street 1:13510 UNIVERSITY PLAZA ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4628
Practice Address - Country:US
Practice Address - Phone:813-278-7113
Practice Address - Fax:888-498-3670
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2025-10-07
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
FLME69066207R00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378585800Medicaid
FLF70871Medicare UPIN
F70871Medicare UPIN
FL27563TMedicare PIN