Provider Demographics
NPI:1376599274
Name:HANSEN, RAYMOND FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:FRANK
Last Name:HANSEN
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 1:801 ROSEHILL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-1762
Mailing Address - Country:US
Mailing Address - Phone:517-212-2008
Mailing Address - Fax:517-212-2009
Practice Address - Street 1:4760 FASHION SQUARE BLVD STE L-1
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2620
Practice Address - Country:US
Practice Address - Phone:989-282-4003
Practice Address - Fax:888-491-7220
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI04-00325OtherPHP
MI200000002583OtherPHP COMMERCIAL
MI200000002583OtherPHP FAMILYCARE
MI4083585Medicaid
MI1001908OtherMCLAREN HEALTH PLAN-MEDICAID
MI4853900Medicaid
MI04-70325OtherPHP FAMILYCARE
MI0M21440006OtherBCBS MEDICARE PLUS BLUE
MI1001908OtherMCLAREN HEALTH ADVANTAGE
MI1103305842OtherBCBS/BCN
MI1001908OtherMCLAREN HEALTH PLAN- COMMERCIAL
MI110169068OtherRAILROAD MEDICARE
MI4453054OtherAETNA
MI1001908OtherMCLAREN HEALTH ADVANTAGE
MI110169068OtherRAILROAD MEDICARE