Provider Demographics
NPI:1881690493
Name:HANSON, DANIEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:W
Last Name:HANSON
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 1:2780 SNELLING AVE N STE 310
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-7125
Mailing Address - Country:US
Mailing Address - Phone:612-670-4971
Mailing Address - Fax:612-404-2580
Practice Address - Street 1:2780 SNELLING AVE N STE 310
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-7125
Practice Address - Country:US
Practice Address - Phone:612-670-4971
Practice Address - Fax:612-404-2580
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48811207XS0117X
MN46458207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34559300Medicaid
MN732689100Medicaid
MN0572890001Medicare NSC
WI56080-0030Medicare PIN
MN200002160Medicare ID - Type UnspecifiedMN MEDICARE NUM
WI49128-0029Medicare PIN
H79015Medicare UPIN