Healthcare Provider Details

I. General information

NPI: 1144787003
Provider Name (Legal Business Name): DR. HASNA BEHNAM IWAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 E JEFFERSON AVE STE 102
GROSSE POINTE PARK MI
48230-2055
US

IV. Provider business mailing address

15200 E JEFFERSON AVE
GROSSE POINTE PARK MI
48230-1304
US

V. Phone/Fax

Practice location:
  • Phone: 586-295-7221
  • Fax: 313-822-8780
Mailing address:
  • Phone: 586-295-7221
  • Fax: 313-822-8780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302410939
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: