Provider Demographics
NPI:1679574891
Name:HASNAIN, WIRASAT (MD)
Entity type:Individual
Prefix:
First Name:WIRASAT
Middle Name:
Last Name:HASNAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E TAYLOR ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 E TAYLOR ST STE 103
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2810
Practice Address - Country:US
Practice Address - Phone:903-893-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2256207RN0300X
MDD0063118207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD646840-01 02OtherCAREFIRST BC BS
WV3810004271Medicaid
MD409565100Medicaid
DCJ697 0006OtherBLUE CHOICE
MDP00299245OtherTRAVELERS MEDICARE
MDI48289Medicare UPIN
MDP00299245OtherTRAVELERS MEDICARE