Provider Demographics
NPI:1639157373
Name:HANSEN, CALVIN J (MD)
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:J
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1221 PLEASANT ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1423
Mailing Address - Country:US
Mailing Address - Phone:515-241-4200
Mailing Address - Fax:515-241-4083
Practice Address - Street 1:1221 PLEASANT ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1423
Practice Address - Country:US
Practice Address - Phone:515-241-4200
Practice Address - Fax:515-241-4083
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-299582084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5110445Medicaid
IA130010229OtherRR MEDICARE
IA1639157373Medicaid
IA3110445Medicaid
IAE85969Medicare UPIN
IA5110445Medicaid