Individual
MIRZA SHAHZAD HASAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
999 ILLINOIS AVE, MAUMEE, OH 43537-1715
(419) 893-5591
(419) 893-0162
Mailing address
999 ILLINOIS AVE, MAUMEE, OH 43537-1715
(419) 893-5591
(419) 893-0162
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
04-27855
KS
208600000X
Surgery Physician
Primary
35.098760
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0072146
—
OH
05
—
100332720B
—
KS
05
—
100332720C
—
KS
01
—
H127590
MEDICARE PTAN
OH
Enumeration date
09/22/2006
Last updated
10/08/2018
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