Provider Demographics
NPI:1902120108
Name:TAWFIQ J.HASSAN MD PC
Entity Type:Organization
Organization Name:TAWFIQ J.HASSAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAWFIQ
Authorized Official - Middle Name:J
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-565-1111
Mailing Address - Street 1:25325 FORD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1086
Mailing Address - Country:US
Mailing Address - Phone:313-565-1111
Mailing Address - Fax:
Practice Address - Street 1:25325 FORD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1086
Practice Address - Country:US
Practice Address - Phone:313-565-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty