Provider Demographics
NPI:1083417455
Name:HANNA, MICHAEL LIONEL JR
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LIONEL
Last Name:HANNA
Suffix:JR
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 1:343 SOUTH DEARBORN STREET
Mailing Address - Street 2:FISHER BUILDING APARTMENTS (APARTMENT 1711)
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604
Mailing Address - Country:US
Mailing Address - Phone:312-996-2933
Mailing Address - Fax:312-996-3050
Practice Address - Street 1:1740 W TAYLOR STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:866-600-2273
Practice Address - Fax:312-996-3050
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125.086443390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program