Provider Demographics
NPI:1710041892
Name:HANNA, DIMA R (MD)
Entity Type:Individual
Prefix:
First Name:DIMA
Middle Name:R
Last Name:HANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17218 N 72ND DR
Mailing Address - Street 2:100
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8562
Mailing Address - Country:US
Mailing Address - Phone:623-334-8670
Mailing Address - Fax:623-334-8675
Practice Address - Street 1:6605 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-1425
Practice Address - Country:US
Practice Address - Phone:623-334-8670
Practice Address - Fax:623-334-8675
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ36060207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine