Healthcare Provider Details

I. General information

NPI: 1326043233
Provider Name (Legal Business Name): STEPHEN HANNAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10018 HARBOUR PINES CT
INDIANAPOLIS IN
46256-9335
US

IV. Provider business mailing address

10018 HARBOUR PINES CT
INDIANAPOLIS IN
46256-9335
US

V. Phone/Fax

Practice location:
  • Phone: 317-430-3975
  • Fax:
Mailing address:
  • Phone: 317-430-3975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01033930A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: