# HASAN M QUTOB

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154480499
- **Authorized official:** HASAN M QUTOB MD (OWNER)
- **Authorized official phone:** (734) 604-9626

## Contact information

- **Practice address:** 817 W HIGH ST, JACKSON, MI 49203-2986
- **Practice address phone:** (734) 604-9626
- **Mailing address:** PO BOX 71, JACKSON, MI 49204-0071

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | 4301070269 | MI | Yes |

## Other

- **Enumeration date:** 12/06/2006
- **Last updated:** 12/26/2015