Healthcare Provider Details

I. General information

NPI: 1558332783
Provider Name (Legal Business Name): HASAN HASABA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 01/07/2024
Certification Date: 01/07/2024
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: 248-559-9080
Mailing address:
  • Phone: 248-559-7958
  • Fax: 248-559-9080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberHH024030
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: