Provider Demographics
NPI:1902880321
Name:ALAM, HASAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:HASAN
Middle Name:B
Last Name:ALAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:259 E ERIE ST STE 1600
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3111
Mailing Address - Country:US
Mailing Address - Phone:312-695-5620
Mailing Address - Fax:312-695-2729
Practice Address - Street 1:259 E ERIE ST STE 1600
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3111
Practice Address - Country:US
Practice Address - Phone:312-695-5620
Practice Address - Fax:312-695-2729
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101784208600000X
MA224253208600000X, 2086S0102X
MI43011047842086S0102X
IL0361533202086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ28695OtherBCBS OF MA
MA2102587Medicaid
MA468294OtherTUFTS HEALTH PLAN
MA468294OtherTUFTS HEALTH PLAN
MAA38616Medicare ID - Type Unspecified