Healthcare Provider Details

I. General information

NPI: 1467693580
Provider Name (Legal Business Name): SAHAR GAMAL HANNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAHAR GAMAL KHALIL MD

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9470 BROADWAY
CROWN POINT IN
46307-5722
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 219-661-3260
  • Fax: 219-662-3770
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number52268
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number249680-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13035-320
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: