MEDICARE: DR. TAWFIQ J HASSAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	TH050895	MI

General Provider Information

NPI Number	:	1144290909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAWFIQ J HASSAN M.D.

Provider Business Mailing Address
First Line	:	2021 MONROE ST
Second Line	:	203
City	:	DEARBORN
State	:	MI
Zip	:	48124-2926
Country	:	US
Telephone Number	:	313-565-1111
Fax Number	:	313-565-3337

Provider Business Practice Location Address
First Line	:	2021 MONROE ST
Second Line	:	203
City	:	DEARBORN
State	:	MI
Zip	:	48124-2926
Country	:	US
Telephone Number	:	313-565-1111
Fax Number	:	313-565-3337

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	03/27/2012

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