MEDICARE: N HASAN MD SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	036091656	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154431971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	N HASAN MD SC

Provider Business Mailing Address
First Line	:	PO BOX 1200
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-8200
Country	:	US
Telephone Number	:	773-978-4330
Fax Number	:

Provider Business Practice Location Address
First Line	:	2315 E 93RD ST STE 339
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-3916
Country	:	US
Telephone Number	:	773-978-4330
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NIDAL HASAN
Credential	:	MD
Telephone Number	:	773-978-4330

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/11/2007

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