Healthcare Provider Details

I. General information

NPI: 1689450751
Provider Name (Legal Business Name): MUHAMMAD HASAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W 22ND ST
SIOUX FALLS SD
57105-1554
US

IV. Provider business mailing address

7325 S RUSSET DR
SIOUX FALLS SD
57108-1544
US

V. Phone/Fax

Practice location:
  • Phone: 605-357-1410
  • Fax:
Mailing address:
  • Phone: 605-709-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0782
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: