Provider Demographics
NPI:1821180381
Name:HANBERG, STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:HANBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3301 COUNTY ROAD 6 E
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-4122
Practice Address - Country:US
Practice Address - Phone:574-264-9635
Practice Address - Fax:574-262-8485
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100460600Medicaid
INP01293866OtherRR MEDICARE
IN000000794976OtherBCBS BMG OSOLO RD
E34625Medicare UPIN
229220Medicare PIN
IN100460600AMedicaid