Provider Demographics
NPI:1629593272
Name:PAUL L. HANNAH, M.D. , M.S. LTD
Entity Type:Organization
Organization Name:PAUL L. HANNAH, M.D. , M.S. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HANNAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS, LTD
Authorized Official - Phone:219-981-4800
Mailing Address - Street 1:3787 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46408-2142
Mailing Address - Country:US
Mailing Address - Phone:219-981-4800
Mailing Address - Fax:219-981-4805
Practice Address - Street 1:3787 GRANT ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46408-2142
Practice Address - Country:US
Practice Address - Phone:219-981-4800
Practice Address - Fax:219-981-4805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100213680AMedicaid