MEDICARE: HASAN IJAZ DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	5951001595	MI

General Provider Information

NPI Number	:	1275429847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HASAN IJAZ DPM

Provider Business Mailing Address
First Line	:	33155 ANNAPOLIS ST
Second Line	:
City	:	WAYNE
State	:	MI
Zip	:	48184-2405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	33155 ANNAPOLIS ST
Second Line	:
City	:	WAYNE
State	:	MI
Zip	:	48184-2405
Country	:	US
Telephone Number	:	360-433-8585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2025
Last Update Date	:	12/29/2025

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Directions to “ HASAN IJAZ DPM” Practice Location

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