Healthcare Provider Details

I. General information

NPI: 1417996067
Provider Name (Legal Business Name): SHAHZAD HASAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 W THUNDERBIRD BLVD SUITE M434
SUN CITY AZ
85351-3004
US

IV. Provider business mailing address

PO BOX 53568 SUN HEALTH CLINICS & PHYSICIAN SERVICES
PHOENIX AZ
85072-3568
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-5622
  • Fax: 623-815-2391
Mailing address:
  • Phone: 623-544-5070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number33716
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number33716
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number43205
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number98-71
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: