Healthcare Provider Details

I. General information

NPI: 1184993404
Provider Name (Legal Business Name): HASAN HASABA MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15990 W 9 MILE RD STE 100
SOUTHFIELD MI
48075-4826
US

IV. Provider business mailing address

15990 W 9 MILE RD STE 100
SOUTHFIELD MI
48075-4826
US

V. Phone/Fax

Practice location:
  • Phone: 248-559-7958
  • Fax: 248-559-0908
Mailing address:
  • Phone: 248-559-7958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: HASAN HASABA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 248-559-7958