Provider Demographics
NPI:1538115589
Name:JAMES J HANUSA MD PLLC
Entity Type:Organization
Organization Name:JAMES J HANUSA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JON
Authorized Official - Last Name:HANUSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-761-4448
Mailing Address - Street 1:2902 59TH ST W
Mailing Address - Street 2:SUITE M
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-7023
Mailing Address - Country:US
Mailing Address - Phone:941-795-7401
Mailing Address - Fax:941-795-7414
Practice Address - Street 1:2902 59TH ST W
Practice Address - Street 2:SUITE M
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-7023
Practice Address - Country:US
Practice Address - Phone:941-795-7401
Practice Address - Fax:941-795-7414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94858207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9947Medicare ID - Type Unspecified