Provider Demographics
NPI:1003956343
Name:PEDIATRIC HEMATOLOGY CLINIC LTD
Entity Type:Organization
Organization Name:PEDIATRIC HEMATOLOGY CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARWAN
Authorized Official - Middle Name:DAOUD
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-322-7595
Mailing Address - Street 1:1000 E 21ST ST
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1035
Mailing Address - Country:US
Mailing Address - Phone:605-322-7595
Mailing Address - Fax:605-322-7599
Practice Address - Street 1:1000 E 21ST ST
Practice Address - Street 2:SUITE 3100
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1035
Practice Address - Country:US
Practice Address - Phone:605-322-7595
Practice Address - Fax:605-322-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD15622080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD3008526OtherMEDICA GROUP NUMBER
SD4997079OtherBCBS OF SD GROUP NUMBER