Provider Demographics
NPI:1588038152
Name:HANNASCH, MICHAEL DILLON (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DILLON
Last Name:HANNASCH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6404 NURSERY DR STE 201
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1688
Mailing Address - Country:US
Mailing Address - Phone:361-345-4566
Mailing Address - Fax:888-849-3841
Practice Address - Street 1:6404 NURSERY DR STE 201
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1688
Practice Address - Country:US
Practice Address - Phone:361-345-4566
Practice Address - Fax:888-849-3841
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10395363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical