Healthcare Provider Details

I. General information

NPI: 1699612093
Provider Name (Legal Business Name): KHAWAJA MUSHAMMAR HASSAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 E SHERMAN BLVD STE 1100
MUSKEGON MI
49444-4607
US

IV. Provider business mailing address

1675 LEAHY ST STE 315A
MUSKEGON MI
49442-5543
US

V. Phone/Fax

Practice location:
  • Phone: 231-672-1690
  • Fax: 231-672-6202
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: