Healthcare Provider Details

I. General information

NPI: 1154648269
Provider Name (Legal Business Name): ZEBA M HASAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 N HALSTED ST STE 402
CHICAGO IL
60642-2607
US

IV. Provider business mailing address

1460 N HALSTED ST STE 402
CHICAGO IL
60642-2607
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-2800
  • Fax: 312-227-9551
Mailing address:
  • Phone: 312-227-2800
  • Fax: 312-227-9551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036133137
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: