Provider Demographics
NPI:1093803884
Name:HANNAN, ELHAMI N (MD)
Entity Type:Individual
Prefix:DR
First Name:ELHAMI
Middle Name:N
Last Name:HANNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:560 GAGE BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-943-5922
Practice Address - Street 1:900 STEVENS DR, FIRST FLOOR
Practice Address - Street 2:KADLEC CLINIC NEPHROLOGY
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-942-3163
Practice Address - Fax:509-943-5922
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2004029821207R00000X
WAMD00042562207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0226114OtherSTATE L&I
MO208352708Medicaid
927583435Medicare ID - Type Unspecified
WAG8869046Medicare PIN
MO208352708Medicaid
WAG8869045Medicare PIN