Provider Demographics
NPI:1548224546
Name:HASAN, ABDUL RAHMAN (MD)
Entity type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:RAHMAN
Last Name:HASAN
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 1:4000 HIGHLAND RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-2167
Mailing Address - Country:US
Mailing Address - Phone:248-738-9500
Mailing Address - Fax:248-738-9502
Practice Address - Street 1:4000 HIGHLAND RD
Practice Address - Street 2:SUITE 109
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2167
Practice Address - Country:US
Practice Address - Phone:248-738-9500
Practice Address - Fax:248-738-9502
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034842207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDS0605OtherRAIL ROAD MEDICARE GROUP PIN
MI700H273300OtherBCBSM GROUP PIN
MI1295023547OtherMHP GROUP NPI
MIA74059OtherHAP
MI4145561-10Medicaid
MI4145561-10Medicaid
MIA74059OtherHAP
MIF74059Medicare UPIN