Healthcare Provider Details

I. General information

NPI: 1083701437
Provider Name (Legal Business Name): ROBERT L. HANNAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 S.W. 62 AVENUE CARDIOVASCULAR DEPT.
MIAMI FL
33155-3009
US

IV. Provider business mailing address

PO BOX 557367
MIAMI FL
33255
US

V. Phone/Fax

Practice location:
  • Phone: 305-663-8401
  • Fax: 305-669-6574
Mailing address:
  • Phone: 786-624-5845
  • Fax: 786-624-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME76954
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: