Provider Demographics
NPI:1346342086
Name:HANSON, DALE A (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:A
Last Name:HANSON
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 1:1515 W ATHERTON RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-5300
Mailing Address - Country:US
Mailing Address - Phone:810-235-1102
Mailing Address - Fax:810-235-9391
Practice Address - Street 1:1515 W ATHERTON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-5300
Practice Address - Country:US
Practice Address - Phone:810-235-1102
Practice Address - Fax:810-235-9391
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301041283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3236062Medicaid
MI3236062Medicaid
MIM23560031Medicare PIN