Healthcare Provider Details

I. General information

NPI: 1295678167
Provider Name (Legal Business Name): LANA HASSAN SERHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23500 PARK ST # 3B
DEARBORN MI
48124-2598
US

IV. Provider business mailing address

5981 FENTON ST
DEARBORN HEIGHTS MI
48127-3271
US

V. Phone/Fax

Practice location:
  • Phone: 313-694-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberS900000807033
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: