Provider Demographics
NPI:1558541524
Name:WILLIAM D HANNA MD PC
Entity Type:Organization
Organization Name:WILLIAM D HANNA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DOMINIC
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-774-3780
Mailing Address - Street 1:25869 KELLY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4997
Mailing Address - Country:US
Mailing Address - Phone:586-774-3780
Mailing Address - Fax:586-774-0098
Practice Address - Street 1:25869 KELLY RD
Practice Address - Street 2:SUITE C
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4997
Practice Address - Country:US
Practice Address - Phone:586-774-3780
Practice Address - Fax:586-774-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWH045614207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDE2675OtherRAILROAD MEDICARE PIN
MI4816147Medicaid
MI4816147Medicaid
MIA75991Medicare UPIN