Healthcare Provider Details

I. General information

NPI: 1053763243
Provider Name (Legal Business Name): JAWAAD HASSAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 08/12/2022
Certification Date: 07/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 HEWITT BLVD
RED WING MN
55066-2848
US

IV. Provider business mailing address

701 HEWETT BLFD
RED WING MN
55066
US

V. Phone/Fax

Practice location:
  • Phone: 651-267-5250
  • Fax:
Mailing address:
  • Phone: 651-267-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301110788
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number71750
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: