Provider Demographics
NPI:1982674347
Name:HANNA, MILAD HELMY (MD)
Entity Type:Individual
Prefix:DR
First Name:MILAD
Middle Name:HELMY
Last Name:HANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MILAD
Other - Middle Name:HELMY HANNA
Other - Last Name:ATTIATALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3702 NEW VISION DR BLDG B
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8175 W US HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:SHIPSHEWANA
Practice Address - State:IN
Practice Address - Zip Code:46565
Practice Address - Country:US
Practice Address - Phone:260-768-7432
Practice Address - Fax:260-768-7482
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301105158207Q00000X
IN01073600A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1982674347Medicaid
MIMI2051250Medicare PIN