Provider Demographics
NPI:1023675840
Name:HANRAHAN, JORDAN ROBERT
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ROBERT
Last Name:HANRAHAN
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:BELOIT HEALTH SYSTEM INC
Mailing Address - Street 2:1969 W HART ROAD
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2230
Mailing Address - Country:US
Mailing Address - Phone:608-364-2293
Mailing Address - Fax:608-364-5525
Practice Address - Street 1:BELOIT HEALTH SYSTEM INC
Practice Address - Street 2:1969 W HART ROAD
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-2230
Practice Address - Country:US
Practice Address - Phone:608-364-2293
Practice Address - Fax:608-364-5525
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2023-09-26
Deactivation Date:2020-04-04
Deactivation Code:
Reactivation Date:2020-07-01
Provider Licenses
StateLicense IDTaxonomies
WI77162207R00000X, 208M00000X
WI77162-21207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100209531Medicaid