Healthcare Provider Details

I. General information

NPI: 1487060828
Provider Name (Legal Business Name): ABDALLA H HASSAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 01/20/2023
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SMITH AVE N STE 400
SAINT PAUL MN
55102-2568
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

V. Phone/Fax

Practice location:
  • Phone: 651-290-0133
  • Fax: 651-290-0133
Mailing address:
  • Phone: 507-284-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number273136
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number66492
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: