Provider Demographics
NPI:1972647196
Name:HASSO, FAWAZ M (MD)
Entity type:Individual
Prefix:DR
First Name:FAWAZ
Middle Name:M
Last Name:HASSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1512 HAMLET DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-5701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33200 DEQUINDRE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5967
Practice Address - Country:US
Practice Address - Phone:586-977-0200
Practice Address - Fax:586-977-0000
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine