Healthcare Provider Details

I. General information

NPI: 1639483670
Provider Name (Legal Business Name): TIFFANY MICAELA HANNIGAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 SPRING ST CUITE 2
JEFFERSONVILLE IN
47130-3748
US

IV. Provider business mailing address

1407 SPRING ST SUITE 2
JEFFERSONVILLE IN
47130-3748
US

V. Phone/Fax

Practice location:
  • Phone: 812-288-9646
  • Fax: 812-283-8391
Mailing address:
  • Phone: 812-288-9646
  • Fax: 812-283-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01068589A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: