Provider Demographics
NPI:1003886417
Name:HANNA, SHERINE (MD)
Entity Type:Individual
Prefix:
First Name:SHERINE
Middle Name:
Last Name:HANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-4547
Mailing Address - Country:US
Mailing Address - Phone:630-479-6445
Mailing Address - Fax:
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:BLDG., RM. 3102
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-8866
Practice Address - Fax:708-216-1249
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36092809207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36092809Medicaid
IL36092809Medicaid
H77113Medicare UPIN
ILK14258Medicare ID - Type Unspecified