Provider Demographics
NPI:1629058318
Name:HAHN, TERRY MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:MICHAEL
Last Name:HAHN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11368 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4372
Mailing Address - Country:US
Mailing Address - Phone:734-403-2222
Mailing Address - Fax:734-403-2400
Practice Address - Street 1:11368 ALLEN RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4372
Practice Address - Country:US
Practice Address - Phone:734-403-2222
Practice Address - Fax:734-403-2400
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006425204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00066824OtherRAILROAD MEDICARE
MI4517451Medicaid
MI4517451Medicaid
MION77330002Medicare ID - Type Unspecified