Provider Demographics
NPI:1487678694
Name:HANNAM, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:HANNAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10020 NICHOLAS STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2188
Mailing Address - Country:US
Mailing Address - Phone:402-393-2023
Mailing Address - Fax:402-393-3244
Practice Address - Street 1:10020 NICHOLAS STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2188
Practice Address - Country:US
Practice Address - Phone:402-393-2023
Practice Address - Fax:402-393-3244
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE176402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01907OtherBC/BS GROUP
NE00748OtherBC/BS INDIVIDUAL
NE130005313OtherRR MEDICARE INDIVIDUAL
NE470542490OtherTRICARE GROUP
NE05-00230OtherSHARE ADVANTAGE LAKESIDE
NE05-00003OtherSHARE ADVANTAGE - BERGAN
IA0931584OtherIOWA MEDICAID INDIVIDUAL
NE47054249012Medicaid
NE656OtherMIDLANDS CHOICE
NE470542490OtherTRICARE GROUP
NED05199Medicare UPIN
NECO2009Medicare PIN