Provider Demographics
NPI:1497135354
Name:EATON RAPIDS FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:EATON RAPIDS FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HANKENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-663-3344
Mailing Address - Street 1:1501 KYLE ST
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-8949
Mailing Address - Country:US
Mailing Address - Phone:517-663-3344
Mailing Address - Fax:517-663-1703
Practice Address - Street 1:1501 KYLE ST
Practice Address - Street 2:
Practice Address - City:EATON RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:48827-8949
Practice Address - Country:US
Practice Address - Phone:517-663-3344
Practice Address - Fax:517-663-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007052207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty