Healthcare Provider Details

I. General information

NPI: 1518655166
Provider Name (Legal Business Name): CHRISTIAN MATTHEW HANNAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 S CLIFF AVE STE 300
INDEPENDENCE MO
64055-6954
US

IV. Provider business mailing address

4801 S CLIFF AVE STE 300
INDEPENDENCE MO
64055-6954
US

V. Phone/Fax

Practice location:
  • Phone: 816-251-5200
  • Fax: 816-251-5299
Mailing address:
  • Phone: 816-251-5200
  • Fax: 816-251-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125081780
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2026001047
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: