Individual
SHAHZAD HASAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12774 BOENKER LN, BRIDGETON, MO 63044-2436
(314) 291-7997
(314) 739-1471
Mailing address
PO BOX 776874, CHICAGO, IL 60677-6874
(314) 291-7997
(314) 739-1471
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2000151353
MO
207RI0200X
Infectious Disease Physician
Primary
2000151353
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H35450
UPIN
—
Enumeration date
05/25/2006
Last updated
11/20/2024
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