Basic Information
| Provider Information | |||||||||
| NPI: | 1467675710 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIR | ||||||||
| FirstName: | HASSAN | ||||||||
| MiddleName: | RIAZ | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13020 N TELECOM PKWY | ||||||||
| Address2: | |||||||||
| City: | TEMPLE TERRACE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336370915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139789700 | ||||||||
| FaxNumber: | 8135586186 | ||||||||
| Practice Location | |||||||||
| Address1: | 13020 N TELECOM PKWY | ||||||||
| Address2: | MCE SOUTH TOWER STE 4200 | ||||||||
| City: | TEMPLE TERRACE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336370925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139789700 | ||||||||
| FaxNumber: | 8135586187 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 09/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD437960 | PA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | ME101597 | FL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0801X | MD437960 | PA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | 207XX0801X | MD46461 | TN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | 207XX0801X | ME101597 | FL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma |
ID Information
| ID | Type | State | Issuer | Description | 102368284 | 05 | PA | MEDICAID | 957508 | 01 | MD | CAREFIRST MD BCBS | OTHER | PENDING | 01 | FL | AETNA | OTHER | PENDING | 01 | FL | AVMED | OTHER | PENDING | 01 | FL | BC/BS | OTHER | PENDING | 01 | FL | CIGNA | OTHER | 2121091 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 026269300 | 05 | FL | MEDICAID |