Provider Demographics
NPI:1780764613
Name:HANIGAN, LAURENCE J (MD)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:J
Last Name:HANIGAN
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 1:501 N 87TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2881
Mailing Address - Country:US
Mailing Address - Phone:402-397-7100
Mailing Address - Fax:402-505-6949
Practice Address - Street 1:501 N 87TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2881
Practice Address - Country:US
Practice Address - Phone:402-397-7100
Practice Address - Fax:402-505-6949
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA230362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI17239Medicare ID - Type UnspecifiedMEDICARE IOWA
IAA02743Medicare UPIN