1104810886 NPI number — SYED M HASSAN MD

Table of content: SYED M HASSAN MD (NPI 1104810886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104810886 NPI number — SYED M HASSAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASSAN
Provider First Name:
SYED
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104810886
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 E APPLE ST
Provider Second Line Business Mailing Address:
SUITE NW 3300
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45409-2939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-208-8394
Provider Business Mailing Address Fax Number:
937-208-8388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 E APPLE ST
Provider Second Line Business Practice Location Address:
SUITE NW 3300
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45409-2939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-208-8394
Provider Business Practice Location Address Fax Number:
937-208-8388
Provider Enumeration Date:
09/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  036-112577 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 35665 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 35.097869 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104474 . This is a "HEALTH ALLIANCE #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1241593 . This is a "CONTROLLED SUBSTANCE#" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 92087 . This is a "IA BC/BS SEEN IN RI" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 92135 . This is a "IA BC/BS SEEN IN MOLINE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: IL01B2 . This is a "JOHN DEERE EDI#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0054680 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0568980 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0568998 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 421060724 . This is a "BILLING TAX ID# FOR CHC" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 036112577 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 336073336 . This is a "CONTROLLED SUBSTANCE#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 421060724B2 . This is a "JOHN DEERE HEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 8122859 . This is a "ILLINOIS BC/BS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 37768 . This is a "IOWABC/BS SEEN IN RD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 421060724005 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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