Healthcare Provider Details

I. General information

NPI: 1306041660
Provider Name (Legal Business Name): EYAD MICHAEL HANNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 NE GLEN OAK AVE STE 201
PEORIA IL
61603-3112
US

IV. Provider business mailing address

420 NE GLEN OAK AVE STE 201
PEORIA IL
61603-3112
US

V. Phone/Fax

Practice location:
  • Phone: 309-624-2277
  • Fax:
Mailing address:
  • Phone: 309-624-2277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number37301
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number036178729
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37301
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: