Healthcare Provider Details

I. General information

NPI: 1124649439
Provider Name (Legal Business Name): HAMZA HANIF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 10/31/2023
Certification Date: 10/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 HOLY CROSS PKWY
MISHAWAKA IN
46545-1469
US

IV. Provider business mailing address

5215 HOLY CROSS PKWY
MISHAWAKA IN
46545-1469
US

V. Phone/Fax

Practice location:
  • Phone: 574-335-2522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01089763A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: