MEDICARE: ALI HASSAN MD

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	207P00000X	Emergency Medicine Physician	4301077883	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	AH077883	OTHER	MI	BC/BS OF MI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316906142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI HASSAN MD

Provider Business Mailing Address
First Line	:	23455 MICHIGAN AVE
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-1908
Country	:	US
Telephone Number	:	313-438-6094
Fax Number	:	313-438-6132

Provider Business Practice Location Address
First Line	:	23455 MICHIGAN AVE
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-1908
Country	:	US
Telephone Number	:	313-438-6094
Fax Number	:	313-438-6132

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	02/24/2015

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Directions to “ ALI HASSAN MD” Practice Location

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