Provider Demographics
NPI:1912624602
Name:OSMAN, HASSAN SHARIFF
Entity type:Individual
Prefix:
First Name:HASSAN
Middle Name:SHARIFF
Last Name:OSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 LYNDALE AVE S STE 180
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-4142
Mailing Address - Country:US
Mailing Address - Phone:507-405-6608
Mailing Address - Fax:
Practice Address - Street 1:7400 LYNDALE AVE S STE 180
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-4142
Practice Address - Country:US
Practice Address - Phone:507-405-6608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty