Healthcare Provider Details

I. General information

NPI: 1992827224
Provider Name (Legal Business Name): JAFAR SYED HASAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 S. WILLOW SPRINGS RD,, SUITE 290
LA GRANGE IL
60559
US

IV. Provider business mailing address

4 E OGDEN AVE # 143
WESTMONT IL
60559-3506
US

V. Phone/Fax

Practice location:
  • Phone: 734-945-1579
  • Fax:
Mailing address:
  • Phone: 734-945-1579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number036.119900
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number036.119900
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number036.119900
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: