Healthcare Provider Details

I. General information

NPI: 1922006097
Provider Name (Legal Business Name): BENJAMIN A HASAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 ROHLWING RD
ROLLING MEADOWS IL
60008-1338
US

IV. Provider business mailing address

1941 ROHLWING RD
ROLLING MEADOWS IL
60008-1338
US

V. Phone/Fax

Practice location:
  • Phone: 847-618-0850
  • Fax: 847-618-0859
Mailing address:
  • Phone: 847-618-0850
  • Fax: 847-618-0859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-082532
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036-082532
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: