MEDICARE: DR. HASAN HASABA 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	HH024030	MI

General Provider Information

NPI Number	:	1558332783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HASAN HASABA M.D.

Provider Business Mailing Address
First Line	:	15990 W 9 MILE RD STE 100
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48075-4826
Country	:	US
Telephone Number	:	248-559-7958
Fax Number	:	248-559-9080

Provider Business Practice Location Address
First Line	:	15990 W 9 MILE RD STE 100
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48075-4826
Country	:	US
Telephone Number	:	248-559-7958
Fax Number	:	248-559-9080

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	01/07/2024

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