Provider Demographics
NPI:1285695874
Name:HASNAIN, HOMA (MD)
Entity type:Individual
Prefix:
First Name:HOMA
Middle Name:
Last Name:HASNAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HENRY FORD MEDICAL GROUP - DETROIT NORTHWEST
Mailing Address - Street 2:7800 W OUTER DRIVE
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235
Mailing Address - Country:US
Mailing Address - Phone:313-653-2300
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD MEDICAL GROUP - DETROIT NORTHWEST
Practice Address - Street 2:7800 W OUTER DRIVE
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:313-653-2300
Practice Address - Fax:313-653-2500
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070129207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HH070129OtherCOMMERCIAL-COMMERCIAL NUMBER
080H262390OtherBLUE CROSS-BLUE CROSS
HH070129OtherCHAMPUS-CHAMPUS
MI494477310Medicaid
0H26239190Medicare ID - Type Unspecified
MI494477310Medicaid