Provider Demographics
NPI:1114929106
Name:HANNA, WAFAA S (MD)
Entity Type:Individual
Prefix:
First Name:WAFAA
Middle Name:S
Last Name:HANNA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1860
Mailing Address - Fax:947-522-0307
Practice Address - Street 1:25319 LITTLE MACK AVE
Practice Address - Street 2:
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3370
Practice Address - Country:US
Practice Address - Phone:586-447-4000
Practice Address - Fax:586-447-4009
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2020-10-21
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Provider Licenses
StateLicense IDTaxonomies
MI4301062012207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3282477Medicaid
MI3282477Medicaid
MIG41313Medicare UPIN