Healthcare Provider Details

I. General information

NPI: 1033347125
Provider Name (Legal Business Name): DAVID MICHAEL HANRAHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAVID M HANRAHAN M.D.

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE
MAYWOOD IL
60153-3328
US

IV. Provider business mailing address

5980 9TH STREET BUILDING #1259 FORT BELVOIR INTREPID PAVILLION
FORT BELVOIR VA
22060
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-2226
  • Fax:
Mailing address:
  • Phone: 706-806-4162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101248027
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number70587
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC169060
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036161396
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: