Provider Demographics
NPI:1124611249
Name:R HANNA, MD, PLLC
Entity type:Organization
Organization Name:R HANNA, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAIED
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-718-9122
Mailing Address - Street 1:30701 WOODWARD AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0991
Mailing Address - Country:US
Mailing Address - Phone:248-288-6500
Mailing Address - Fax:248-288-2272
Practice Address - Street 1:30701 WOODWARD AVE STE 314
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0991
Practice Address - Country:US
Practice Address - Phone:248-288-6500
Practice Address - Fax:248-288-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty