Provider Demographics
NPI:1043287733
Name:HANSEN, ERIC E (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:E
Last Name:HANSEN
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 1:2419 SW PEPPERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4231
Mailing Address - Country:US
Mailing Address - Phone:785-231-7173
Mailing Address - Fax:
Practice Address - Street 1:2419 SW PEPPERWOOD RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-4231
Practice Address - Country:US
Practice Address - Phone:785-231-7173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-23119208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200449601Medicaid
MO219322OtherANTHEM
KS100119540BMedicaid
P00403959OtherRR MEDICARE
OK200111120AMedicaid
KS100119540BMedicaid
E52239Medicare UPIN