Provider Demographics
NPI:1770087561
Name:HANSARD, JOHANNES ANDRE (CPS)
Entity type:Individual
Prefix:
First Name:JOHANNES
Middle Name:ANDRE
Last Name:HANSARD
Suffix:
Gender:M
Credentials:CPS
Other - Prefix:MR
Other - First Name:JOHANNES
Other - Middle Name:ANDRE
Other - Last Name:HANSARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPS
Mailing Address - Street 1:2840 E 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-3707
Mailing Address - Country:US
Mailing Address - Phone:614-615-1423
Mailing Address - Fax:
Practice Address - Street 1:2840 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-3707
Practice Address - Country:US
Practice Address - Phone:614-615-1423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00305175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty