Provider Demographics
NPI:1821100389
Name:HAN M HANAFY MDSC
Entity Type:Organization
Organization Name:HAN M HANAFY MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANAFY
Authorized Official - Suffix:
Authorized Official - Credentials:MDSC
Authorized Official - Phone:6182-527-4724
Mailing Address - Street 1:PO BOX 783
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-0783
Mailing Address - Country:US
Mailing Address - Phone:618-252-7424
Mailing Address - Fax:618-252-0737
Practice Address - Street 1:404 N COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-3307
Practice Address - Country:US
Practice Address - Phone:618-252-7424
Practice Address - Fax:618-252-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-45949208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL101929OtherBLACK LUNG
IL036045949Medicaid
IL08300064OtherBLUE CROSS BLUE SHIELD
IL108688OtherHEALTHLINK
ILL002199OtherCHAMPUS
IL0065501OtherUMWA THE FUNDS
IL08300064OtherBLUE CROSS BLUE SHIELD
IL0649820001Medicare NSC
IN233210Medicare PIN