Provider Demographics
NPI:1902817364
Name:HANKINS, MICHAEL K (CRNA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:K
Last Name:HANKINS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SOUTHFIELD DR
Mailing Address - Street 2:SUITE 1370
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4498
Mailing Address - Country:US
Mailing Address - Phone:317-837-5571
Mailing Address - Fax:317-837-5580
Practice Address - Street 1:1000 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1948
Practice Address - Country:US
Practice Address - Phone:317-745-4451
Practice Address - Fax:317-718-6740
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28118655A367500000X
OHRN193589367500000X
KY1064618367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000542738OtherANTHEM
KY74370610Medicaid
IN430078077OtherRAILROAD MEDICARE
IN000000110859OtherANTHEM
OH0807916Medicaid
IN100359380Medicaid
IN000000642061OtherANTHEM PROVIDER NUMBER
IN815500DD8Medicare PIN
INCC1060AMedicare PIN
IN000000110859OtherANTHEM
OH0807916Medicaid