Provider Demographics
NPI:1023006806
Name:HANNA, ENAM BEHNAM (MD)
Entity Type:Individual
Prefix:
First Name:ENAM
Middle Name:BEHNAM
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 1:501 LAPEER AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1208
Mailing Address - Country:US
Mailing Address - Phone:989-759-6464
Mailing Address - Fax:989-399-8233
Practice Address - Street 1:1522 JANES AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-1819
Practice Address - Country:US
Practice Address - Phone:989-755-0316
Practice Address - Fax:989-755-0956
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064323207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080G310660OtherPPO TRUST
MI1023006806OtherMOLINA HEALTHCARE OF MICHIGAN
MI381908328OtherPRIORITY HEALTH
MI080G310660OtherBCN COMMERCIAL
MI080G310660OtherBLUE PREFERRED PLUS BPP
381908328OtherHCAP
MI080G310660OtherMEDICARE PLUS BLUE PPO
MI30341OtherHEALTH PLAN OF MICHIGAN
1010150OtherHEALTH ADVANTAGE PPO
381908328OtherTRICARE
MI1023006806Medicaid
MI080G310660OtherBCBS TRADITIONAL
MI0983112OtherHEALTHPLUS
MI103OtherCOMMUNITY CHOICE
381908328OtherPPOM
1010150OtherMCLAREN HEALTH PLAN
MI108734OtherGREAT LAKES HEALTH PLAN OF MICHIGAN
5836577OtherAETNA
MI080G310660OtherBCN COMMERCIAL
MI080G310660OtherPPO TRUST
G53498Medicare UPIN