Provider Demographics
NPI:1477578920
Name:HANNA, NAGUI Y (MD)
Entity Type:Individual
Prefix:
First Name:NAGUI
Middle Name:Y
Last Name:HANNA
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 1:16221 W 159TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-7959
Mailing Address - Country:US
Mailing Address - Phone:815-588-1111
Mailing Address - Fax:815-838-4305
Practice Address - Street 1:16221 W 159TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-7959
Practice Address - Country:US
Practice Address - Phone:815-588-1111
Practice Address - Fax:815-838-4305
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068369207P00000X
IL036-068369208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
C40848Medicare UPIN