Provider Demographics
NPI:1972723831
Name:HANNOSH, MIKE MANUEL
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:MANUEL
Last Name:HANNOSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E LEAH LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2369
Mailing Address - Country:US
Mailing Address - Phone:480-612-3083
Mailing Address - Fax:480-635-9533
Practice Address - Street 1:309 E LEAH LN
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2369
Practice Address - Country:US
Practice Address - Phone:480-612-3083
Practice Address - Fax:480-635-9533
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver