Healthcare Provider Details

I. General information

NPI: 1710778402
Provider Name (Legal Business Name): SARAH I HASAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 12/27/2025
Certification Date: 12/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8518 S 78TH AVE
BRIDGEVIEW IL
60455-1753
US

IV. Provider business mailing address

8518 S 78TH AVE
BRIDGEVIEW IL
60455-1753
US

V. Phone/Fax

Practice location:
  • Phone: 708-980-6884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.011904
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: