Provider Demographics
NPI:1497753669
Name:HANNUN, GHALEB ALI (MD)
Entity Type:Individual
Prefix:
First Name:GHALEB
Middle Name:ALI
Last Name:HANNUN
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 1:750 MOUNT CARMEL MALL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1553
Mailing Address - Country:US
Mailing Address - Phone:614-545-2994
Mailing Address - Fax:614-545-2999
Practice Address - Street 1:750 MOUNT CARMEL MALL
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1553
Practice Address - Country:US
Practice Address - Phone:614-545-2994
Practice Address - Fax:614-545-2999
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044225208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0489494Medicaid
OH0489494Medicaid
A80364Medicare UPIN