Provider Demographics
NPI:1013206556
Name:MARIANI, HANNA (MD)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:MARIANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HANNA
Other - Middle Name:
Other - Last Name:SURAWSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6308 8TH AVE
Mailing Address - Street 2:ATTN: MEDICAL STAFF OFFICE
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5031
Mailing Address - Country:US
Mailing Address - Phone:262-656-3313
Mailing Address - Fax:262-653-5850
Practice Address - Street 1:6308 8TH AVE
Practice Address - Street 2:STE 3070
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5031
Practice Address - Country:US
Practice Address - Phone:262-656-3710
Practice Address - Fax:262-656-3715
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66687-20207RE0101X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI13905857OtherCAQH
WI1013206556Medicaid
WI66687-20OtherWI LICENSE
WI13905857OtherCAQH