Healthcare Provider Details

I. General information

NPI: 1740103258
Provider Name (Legal Business Name): HASAN ABUL-KHAIR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W DOUGLAS ST
FREEPORT IL
61032-4129
US

IV. Provider business mailing address

10611 NW 18TH DR
PLANTATION FL
33322-3546
US

V. Phone/Fax

Practice location:
  • Phone: 954-496-3446
  • Fax:
Mailing address:
  • Phone: 954-496-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019037389
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: