Provider Demographics
NPI:1962476531
Name:HANNA, MATTHEW HARVEY (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:HARVEY
Last Name:HANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2514 S 102ND ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2142
Mailing Address - Country:US
Mailing Address - Phone:414-777-5200
Mailing Address - Fax:414-777-5210
Practice Address - Street 1:2901 W KINNICKINNIC RIVER PKWY STE 413
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3660
Practice Address - Country:US
Practice Address - Phone:414-383-7744
Practice Address - Fax:414-383-8089
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25834207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30601000Medicaid
WIB53375Medicare UPIN
WI30601000Medicaid