Provider Demographics
NPI:1265051551
Name:HASAN, KAAZIM MUKHTAAR
Entity type:Individual
Prefix:
First Name:KAAZIM
Middle Name:MUKHTAAR
Last Name:HASAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36750 26 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-2920
Mailing Address - Country:US
Mailing Address - Phone:586-879-2000
Mailing Address - Fax:
Practice Address - Street 1:36750 26 MILE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-2920
Practice Address - Country:US
Practice Address - Phone:586-879-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME164029207P00000X
IN01090719A207P00000X
MI4301509205207P00000X
WI83228-20207P00000X
MDD0100841207P00000X
IL036165270207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine