Provider Demographics
NPI:1689677957
Name:CHICHANE, HANANE (MD)
Entity Type:Individual
Prefix:
First Name:HANANE
Middle Name:
Last Name:CHICHANE
Suffix:
Gender:F
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:PO BOX 1899
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76097-1899
Mailing Address - Country:US
Mailing Address - Phone:817-426-3323
Mailing Address - Fax:817-426-3353
Practice Address - Street 1:115 NW NEWTON DR STE C
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4793
Practice Address - Country:US
Practice Address - Phone:817-426-3323
Practice Address - Fax:817-426-3353
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
TXM10522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174942602Medicaid
TX8CD160OtherBCBS
TX174942603Medicaid
TX8F22583Medicare PIN