Provider Demographics
NPI:1215722442
Name:HASSAN, LIBAN
Entity type:Individual
Prefix:
First Name:LIBAN
Middle Name:
Last Name:HASSAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 OAK DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56024-3404
Mailing Address - Country:US
Mailing Address - Phone:507-491-0668
Mailing Address - Fax:
Practice Address - Street 1:1290 SALEM RD SW # 10
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-4210
Practice Address - Country:US
Practice Address - Phone:507-686-6968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program