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Individual

SYED MAHMOOD HASAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
7165 CLEARVISTA WAY, INDIANAPOLIS, IN 46256-4621
(317) 621-5100
(317) 621-7896
Mailing address
6626 E 75TH STREET, SUITE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-7561
(317) 355-6096

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01057120A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000653878
ANTHEM
IN
01
000000721882
ANTHEM
IN
01
000000983429
ANTHEM PIN
IN
05
200858960
IN
01
244724
VALUE OPTIONS
IN
01
284745
MANAGED HEALTH NETWORK
IN
05
71255583
NM
01
P01191764
RR MEDICARE PTAN
IN
Enumeration date
07/07/2006
Last updated
10/03/2022
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