Provider Demographics
NPI:1396780417
Name:HANNAH, BARBARA ANN (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:HANNAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14184 LONGACRE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1357
Mailing Address - Country:US
Mailing Address - Phone:313-388-4247
Mailing Address - Fax:313-388-4827
Practice Address - Street 1:25050 OUTER DR
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-1297
Practice Address - Country:US
Practice Address - Phone:313-388-4247
Practice Address - Fax:313-388-4827
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBH063985207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0827291OtherBLUE CROSS BLUE SHIELD MI
MI4365322Medicaid
MI0827291OtherBLUE CROSS BLUE SHIELD MI
MI0N43370Medicare ID - Type Unspecified
MI4365322Medicaid