MEDICARE: DR. FIRASATH HASAN 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	208000000X	Pediatrics Physician	036.049888	IL

General Provider Information

NPI Number	:	1366711400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FIRASATH HASAN M.D.

Provider Business Mailing Address
First Line	:	25 E SUPERIOR ST
Second Line	:	3404
City	:	CHICAGO
State	:	IL
Zip	:	60611-2547
Country	:	US
Telephone Number	:	312-787-5501
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 E SUPERIOR ST
Second Line	:	3404
City	:	CHICAGO
State	:	IL
Zip	:	60611-2547
Country	:	US
Telephone Number	:	312-787-5501
Fax Number	:

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

Provider Enumeration Date	:	12/19/2011
Last Update Date	:	12/19/2011

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