Healthcare Provider Details

I. General information

NPI: 1689686529
Provider Name (Legal Business Name): WAFAA G HANNA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18210 LA GRANGE RD STE 109
TINLEY PARK IL
60477-7723
US

IV. Provider business mailing address

8650 TIMBER RIDGE DR
BURR RIDGE IL
60527-5693
US

V. Phone/Fax

Practice location:
  • Phone: 708-478-4666
  • Fax: 708-478-8444
Mailing address:
  • Phone: 630-230-0650
  • Fax: 630-230-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: