MEDICARE: NIDAL HASAN 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	036091656	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01621679	OTHER	IL	BCBS OF IL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326024134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIDAL HASAN MD

Provider Business Mailing Address
First Line	:	PO BOX 1200
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-8200
Country	:	US
Telephone Number	:	773-820-0928
Fax Number	:

Provider Business Practice Location Address
First Line	:	1747 E 87TH ST
Second Line	:	B-390
City	:	CHICAGO
State	:	IL
Zip	:	60617-2741
Country	:	US
Telephone Number	:	773-978-4330
Fax Number	:

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	12/24/2021

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