Provider Demographics
NPI:1699869503
Name:ALI-HASAN, SAMER AHMAD (MD)
Entity type:Individual
Prefix:
First Name:SAMER
Middle Name:AHMAD
Last Name:ALI-HASAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 W SUGNET RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2647
Mailing Address - Country:US
Mailing Address - Phone:989-832-0900
Mailing Address - Fax:989-633-0349
Practice Address - Street 1:2660 W SUGNET RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2647
Practice Address - Country:US
Practice Address - Phone:989-832-0900
Practice Address - Fax:989-633-0349
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063288A207RC0000X
OH35.094208207RC0000X
IL036121333207RC0000X, 207RI0011X
LAMD202142207RI0011X
MI4301101928207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1141500Medicaid
IN251320NNMedicare PIN
OH4311751Medicare PIN
LA4N150Medicare PIN
LA1141500Medicaid