Provider Demographics
NPI:1790183226
Name:M. MICHAEL HANNA, DO, PA
Entity Type:Organization
Organization Name:M. MICHAEL HANNA, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MOUSA
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-659-6023
Mailing Address - Street 1:1411 N FLAGLER DR
Mailing Address - Street 2:SUITE 6300
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3404
Mailing Address - Country:US
Mailing Address - Phone:561-659-6023
Mailing Address - Fax:561-659-6025
Practice Address - Street 1:1411 N FLAGLER DR
Practice Address - Street 2:SUITE 6300
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3404
Practice Address - Country:US
Practice Address - Phone:561-659-6023
Practice Address - Fax:561-659-6025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6942261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG03278Medicare UPIN