Healthcare Provider Details

I. General information

NPI: 1891705745
Provider Name (Legal Business Name): BISCHAN HASSUNIZADEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 PAGE AVE SUITE B
JACKSON MI
49201
US

IV. Provider business mailing address

2271 CHARTER DR APT 106
TROY MI
48083
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-3577
  • Fax: 517-787-4280
Mailing address:
  • Phone: 248-619-7465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301080801
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301080801
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: