MEDICARE: TAWFIQ J.HASSAN MD PC

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	207R00000X	Internal Medicine Physician	4301050895	MI

General Provider Information

NPI Number	:	1902120108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAWFIQ J.HASSAN MD PC

Provider Business Mailing Address
First Line	:	25325 FORD RD
Second Line	:	SUITE 100
City	:	DEARBORN
State	:	MI
Zip	:	48128-1086
Country	:	US
Telephone Number	:	313-565-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	25325 FORD RD
Second Line	:	SUITE 100
City	:	DEARBORN
State	:	MI
Zip	:	48128-1086
Country	:	US
Telephone Number	:	313-565-1111
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TAWFIQ J HASSAN
Credential	:	MD
Telephone Number	:	313-565-1111

Provider Enumeration Date	:	03/17/2010
Last Update Date	:	10/13/2010

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