Healthcare Provider Details

I. General information

NPI: 1013206556
Provider Name (Legal Business Name): HANNA MARIANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNA SURAWSKA

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6308 8TH AVE STE 3070
KENOSHA WI
53143-5031
US

IV. Provider business mailing address

6308 8TH AVE ATTN: MEDICAL STAFF OFFICE
KENOSHA WI
53143-5031
US

V. Phone/Fax

Practice location:
  • Phone: 262-656-3710
  • Fax: 262-656-3715
Mailing address:
  • Phone: 262-656-3313
  • Fax: 262-653-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number66687-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: