Provider Demographics
NPI:1982414819
Name:HASAN, IQBAL
Entity type:Individual
Prefix:
First Name:IQBAL
Middle Name:
Last Name:HASAN
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 1:27331 DELLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1352
Mailing Address - Country:US
Mailing Address - Phone:440-319-9477
Mailing Address - Fax:
Practice Address - Street 1:27331 DELLWOOD DR
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1352
Practice Address - Country:US
Practice Address - Phone:440-319-9477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide