Provider Demographics
NPI:1689172504
Name:MICHAEL HANNON MD PC
Entity Type:Organization
Organization Name:MICHAEL HANNON MD PC
Other - Org Name:HANNON ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:HANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-433-1654
Mailing Address - Street 1:3 STRATFORD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-7224
Mailing Address - Country:US
Mailing Address - Phone:703-774-4850
Mailing Address - Fax:
Practice Address - Street 1:99 N LA CIENEGA BLVD STE 304
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2286
Practice Address - Country:US
Practice Address - Phone:310-362-3099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123393207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty