Healthcare Provider Details

I. General information

NPI: 1235355876
Provider Name (Legal Business Name): ROBIN HANNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 12/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 W BELDEN AVE UNIT E
CHICAGO IL
60614-3331
US

IV. Provider business mailing address

737 W BELDEN AVE UNIT E
CHICAGO IL
60614-3331
US

V. Phone/Fax

Practice location:
  • Phone: 773-263-9270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number36112298
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number36112298
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: