Provider Demographics
NPI:1265609903
Name:HANAK, MICHAEL A (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:HANAK
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 1:1700 W VAN BUREN ST STE 470
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3291
Mailing Address - Country:US
Mailing Address - Phone:312-942-0400
Mailing Address - Fax:312-942-0406
Practice Address - Street 1:1700 W VAN BUREN ST STE 470
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3291
Practice Address - Country:US
Practice Address - Phone:312-942-0400
Practice Address - Fax:312-942-0406
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036124086OtherLICENSE
IL036124086OtherLICENSE
IL204591Medicare PIN