Provider Demographics
NPI:1184782138
Name:HANEY, JAMES (DO)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:HANEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17555 OAK DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2746
Mailing Address - Country:US
Mailing Address - Phone:313-861-3275
Mailing Address - Fax:
Practice Address - Street 1:23077 GREENFIELD RD STE 489
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3740
Practice Address - Country:US
Practice Address - Phone:248-423-3900
Practice Address - Fax:248-423-8169
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJH005593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4539332Medicaid
MION71990003Medicare ID - Type Unspecified
MIF05646Medicare UPIN