Provider Demographics
NPI:1588642359
Name:HAHN, PETER Y (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:Y
Last Name:HAHN
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 1:225 S PINE ST STE 120
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2377
Mailing Address - Country:US
Mailing Address - Phone:812-524-3328
Mailing Address - Fax:812-524-3326
Practice Address - Street 1:225 S PINE ST STE 120
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2377
Practice Address - Country:US
Practice Address - Phone:812-524-3328
Practice Address - Fax:812-524-3326
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301109040207RC0200X
MN40944207RP1001X
IN01072782A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN083027500Medicaid
MI4301109040OtherSTATE LICENSE
MI1588642359Medicaid
MN083027500Medicaid