Provider Demographics
NPI:1346231578
Name:HANAU, MICHAEL SANFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SANFORD
Last Name:HANAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2426
Mailing Address - Country:US
Mailing Address - Phone:781-461-8779
Mailing Address - Fax:617-726-7541
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:WACC-812
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-724-6300
Practice Address - Fax:617-727-7541
Is Sole Proprietor?:No
Enumeration Date:2005-11-05
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1514652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3170977Medicaid
MAJ18111OtherBLUE CROSS/BLUE SHIELD MA
MAA22989Medicare PIN
MAJ18111OtherBLUE CROSS/BLUE SHIELD MA
MAHA A22898Medicare ID - Type Unspecified