Healthcare Provider Details

I. General information

NPI: 1922532274
Provider Name (Legal Business Name): SEBA HASAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 CLAYTON RD
RICHMOND HEIGHTS MO
63117-1811
US

IV. Provider business mailing address

1716 STIFEL LANE DR
CHESTERFIELD MO
63017-8046
US

V. Phone/Fax

Practice location:
  • Phone: 314-768-8000
  • Fax:
Mailing address:
  • Phone: 216-316-9971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2020019630
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2020019630
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: