MEDICARE: ASHRAF H HANNA MD

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	207Q00000X	Family Medicine Physician	01043537	IN
2	207V00000X	Obstetrics & Gynecology Physician	01043537A	IN
3	207Q00000X	Family Medicine Physician	01043537A	IN

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	:	1720153919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHRAF H HANNA MD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7411 HOPE DR STE C
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-5687
Country	:	US
Telephone Number	:	260-234-5400
Fax Number	:	260-234-5395

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	01/09/2025

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