MEDICARE: DR. OSAMAH HASAN

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	390200000X	Student in an Organized Health Care Education/Training Program		IL
2	208800000X	Urology Physician	V6949	TX

General Provider Information

NPI Number	:	1386205011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OSAMAH HASAN

Provider Business Mailing Address
First Line	:	1101 6TH AVE STE 110
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4929
Country	:	US
Telephone Number	:	817-912-8570
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 6TH AVE STE 110
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4929
Country	:	US
Telephone Number	:	817-912-8570
Fax Number	:

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

Provider Enumeration Date	:	06/24/2019
Last Update Date	:	07/08/2025

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Directions to “ DR. OSAMAH HASAN ” Practice Location

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