Healthcare Provider Details

I. General information

NPI: 1467442251
Provider Name (Legal Business Name): DUANE ANTHONY HANZEL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 MAINE ST
QUINCY IL
62305-5875
US

IV. Provider business mailing address

1005 BROADWAY ST
QUINCY IL
62301-2834
US

V. Phone/Fax

Practice location:
  • Phone: 217-214-3823
  • Fax: 217-277-5596
Mailing address:
  • Phone: 217-223-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number2002006340
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number016-005009
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: