Provider Demographics
NPI:1841588696
Name:HANNA, TIMOTHY D (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:D
Last Name:HANNA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3901 DUTCHMANS LN
Mailing Address - Street 2:STE 104
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4726
Mailing Address - Country:US
Mailing Address - Phone:502-365-1899
Mailing Address - Fax:502-265-1338
Practice Address - Street 1:3901 DUTCHMANS LN STE 104
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4726
Practice Address - Country:US
Practice Address - Phone:502-365-1899
Practice Address - Fax:502-365-1338
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00382213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100322590Medicaid
IN300041548Medicaid