Provider Demographics
NPI:1740246222
Name:HANNA, WILLIAM DOMINIC (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DOMINIC
Last Name:HANNA
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 1:25869 KELLY
Mailing Address - Street 2:STE C
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066
Mailing Address - Country:US
Mailing Address - Phone:586-774-3780
Mailing Address - Fax:586-774-0098
Practice Address - Street 1:25869 KELLY
Practice Address - Street 2:STE C
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066
Practice Address - Country:US
Practice Address - Phone:586-774-3780
Practice Address - Fax:586-774-0098
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWH045614207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00282000OtherRAILROAD MEDICARE PIN
MI4816147Medicaid
MI290501782OtherBCBSM
A75991Medicare UPIN
MI0P26150001Medicare PIN