Healthcare Provider Details

I. General information

NPI: 1134191802
Provider Name (Legal Business Name): TINA M HAHN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 LONG RAPIDS RD
ALPENA MI
49707-1317
US

IV. Provider business mailing address

1501 W CHISHOLM ST
ALPENA MI
49707-1401
US

V. Phone/Fax

Practice location:
  • Phone: 989-356-0504
  • Fax: 989-356-6981
Mailing address:
  • Phone: 989-356-0504
  • Fax: 989-356-6981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01054444A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: