Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 4301072606 | MI |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 4301072606 | MI |
NPI | 1225039563 |
---|---|
Provider Name | Sohail Akhtar Hassan |
First Address | Southfield, MI 48033-3849 |
Second Address | Dearborn, MI 48124-2853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 22/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060-501-2292 | BLUE CROSS BLUE SHIELD (01) | MI |
BH7224342 | DEA (01) | MI |
H59545 | (02) | |
OH-26467014 | MEDICARE ID (01) | MI |