Provider Demographics
NPI:1528099397
Name:DAKROUB, HASSAN N (MD)
Entity type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:N
Last Name:DAKROUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3735 MONROE ST
Mailing Address - Street 2:STE A
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3787
Mailing Address - Country:US
Mailing Address - Phone:313-914-3370
Mailing Address - Fax:313-908-9128
Practice Address - Street 1:3735 MONROE ST STE A
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3787
Practice Address - Country:US
Practice Address - Phone:313-914-3370
Practice Address - Fax:313-908-9128
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087179207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301087179OtherSTATE LICENSE NUMBER