MEDICARE: JOHN PIERRUS HANSON JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	17515	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275536450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN PIERRUS HANSON JR. M.D.

Provider Business Mailing Address
First Line	:	2901 W KINNICKINNIC RIVER PKWY
Second Line	:	STE 516
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-3660
Country	:	US
Telephone Number	:	414-385-3086
Fax Number	:	414-672-1985

Provider Business Practice Location Address
First Line	:	2901 W KINNICKINNIC RIVER PKWY
Second Line	:	STE 415
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-3660
Country	:	US
Telephone Number	:	414-385-3086
Fax Number	:	414-672-1985

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/17/2008

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Directions to “ JOHN PIERRUS HANSON JR. M.D.” Practice Location

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