Provider Demographics
NPI:1417059536
Name:HANNAH, JOE M (MD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:M
Last Name:HANNAH
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 1:4115 OFFICE PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-2408
Mailing Address - Country:US
Mailing Address - Phone:317-297-3507
Mailing Address - Fax:317-290-2557
Practice Address - Street 1:4115 OFFICE PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2408
Practice Address - Country:US
Practice Address - Phone:317-297-3507
Practice Address - Fax:317-290-2557
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01025363A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000083794OtherBCBS