Provider Demographics
NPI:1013972926
Name:HANAVAN, WILLIAM FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:FRANCIS
Last Name:HANAVAN
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 1:3304 COOLEY CT
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-7430
Mailing Address - Country:US
Mailing Address - Phone:269-349-2266
Mailing Address - Fax:269-349-0792
Practice Address - Street 1:3304 COOLEY CT
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-7430
Practice Address - Country:US
Practice Address - Phone:269-349-2266
Practice Address - Fax:269-349-0792
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWH053362207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI100C910690OtherBCBSM
MI0P56360001OtherMEDICARE ID 04/25/2008 AND AFTER
MI1013972926Medicaid
MI10417171759Medicaid
MI383309299134OtherCARESOURCE MEDICAID
MI100C914640OtherBCBS 04/25/2008 AND AFTER
MI1851569958OtherNPI 04/25/2008 AND AFTER
MI1013972926OtherNPI
MIWH053362OtherBLUE CROSS BLUE SHIELD
MI0M92920006OtherMEDICARE
MI101173OtherGREAT LAKES HEALTH PLAN
MI1417961137OtherBCBSM - BRONSON
MI1417961137OtherBCBSM - BRONSON
MI1013972926OtherNPI
MI100C914640OtherBCBS 04/25/2008 AND AFTER
MIF05589Medicare UPIN