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General NPI Number Information
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NPI Number | 1003443300
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Entity Type | Individual
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Provider Name | MICHAEL MYUNG-SUP HAN MD
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Gender | Male
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 201 PENNSYLVANIA PKWY STE 225
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City | CARMEL
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State | IN
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Zip | 46280-1399
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Country | US
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Telephone | 317-573-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 201 PENNSYLVANIA PKWY STE 225
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City | CARMEL
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State | IN
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Zip | 46280-1399
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Country | US
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Telephone | 317-573-1000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | 01095260B
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | 01095260A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A184732
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207WX0109X
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Taxonomy Name | Neuro-ophthalmology Physician
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License Number | A184732
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License Number State | CA
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