MEDICARE: HASAN MEDICAL CENTER, PLC

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	ME69066	FL

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

General Provider Information

NPI Number	:	1821196163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HASAN MEDICAL CENTER, PLC

Provider Business Mailing Address
First Line	:	5420 WEBB RD STE B2
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3255
Country	:	US
Telephone Number	:	813-868-6188
Fax Number	:	813-868-6189

Provider Business Practice Location Address
First Line	:	5420 WEBB RD STE B2
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3255
Country	:	US
Telephone Number	:	813-868-6188
Fax Number	:	813-868-6189

Authorized Official
Title or Position	:	DOCTOR
Name	:	TARIK HASAN
Credential	:	M.D.
Telephone Number	:	813-600-9039

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	12/06/2011

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