Provider Demographics
NPI:1154431971
Name:N HASAN MD SC
Entity type:Organization
Organization Name:N HASAN MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-978-4330
Mailing Address - Street 1:PO BOX 1200
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-8200
Mailing Address - Country:US
Mailing Address - Phone:773-978-4330
Mailing Address - Fax:
Practice Address - Street 1:2315 E 93RD ST STE 339
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3916
Practice Address - Country:US
Practice Address - Phone:773-978-4330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091656207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200241230AMedicaid
IL036091656Medicaid
IN221300Medicare ID - Type UnspecifiedMEDICARE OF INDIANA
ILG19287Medicare UPIN
IL210138Medicare ID - Type UnspecifiedMEDICARE PROVIDER #