Healthcare Provider Details

I. General information

NPI: 1841492188
Provider Name (Legal Business Name): SYED Z HASAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 CAMPUS DR STE 400
PLYMOUTH MN
55441-2659
US

IV. Provider business mailing address

601 JACOB LN
ANOKA MN
55303-1776
US

V. Phone/Fax

Practice location:
  • Phone: 763-577-7400
  • Fax: 763-236-2650
Mailing address:
  • Phone: 763-587-4200
  • Fax: 763-587-4205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number55912
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: