Provider Demographics
NPI:1104933621
Name:HASAN, SUHEB MASHKOOR (MD)
Entity type:Individual
Prefix:DR
First Name:SUHEB
Middle Name:MASHKOOR
Last Name:HASAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3815 PELHAM ST
Mailing Address - Street 2:STE 1
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3852
Mailing Address - Country:US
Mailing Address - Phone:313-583-3915
Mailing Address - Fax:313-593-3810
Practice Address - Street 1:3815 PELHAM ST
Practice Address - Street 2:STE 1
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3852
Practice Address - Country:US
Practice Address - Phone:313-593-3915
Practice Address - Fax:313-792-8812
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2017-01-05
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Provider Licenses
StateLicense IDTaxonomies
MI43010888482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1408292901OtherBCBS
MI1140933621Medicaid
MI1408292901OtherBCN
MI1408294671OtherBC
MI1408294671OtherBCN
MI39663OtherHEALTH PLAN OF MI
MI0229367OtherDEPT OF LABOR
MI166233OtherGREAT LAKES
MIP00632361OtherRAILROAD MEDICARE
MI1140933621Medicaid
MI1408294671OtherBCN