Healthcare Provider Details

I. General information

NPI: 1376718932
Provider Name (Legal Business Name): MRS. RABIA HASAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RABIA HASAN M.D.

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9055 SPRINGBROOK DR NW
COON RAPIDS MN
55433-5841
US

IV. Provider business mailing address

2925 CHICAGO AVE # MR 10860
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 763-780-9155
  • Fax:
Mailing address:
  • Phone: 612-262-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53703
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT191988
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: