Provider Demographics
NPI:1750382263
Name:HANNEMANN, MARTIN D (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:D
Last Name:HANNEMANN
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 1:1550 S POTOMAC ST
Mailing Address - Street 2:STE. 370
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-5455
Mailing Address - Country:US
Mailing Address - Phone:303-369-1080
Mailing Address - Fax:303-750-4913
Practice Address - Street 1:1550 S POTOMAC ST
Practice Address - Street 2:STE. 370
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5455
Practice Address - Country:US
Practice Address - Phone:303-369-1080
Practice Address - Fax:303-750-4913
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84087252103OtherPACIFICARE/SECURE HORIZON
CO31663OtherANTHEM BLUE CROSS
COE23291Medicare UPIN
CO84087252103OtherPACIFICARE/SECURE HORIZON