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General NPI Number Information
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NPI Number | 1043336852
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Entity Type | Individual
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Provider Name | MICHAEL JOSEPH HANNA M.S.ED, ATC
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Gender | Male
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 430 S MICHIGAN AVE RM 362
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City | CHICAGO
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State | IL
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Zip | 60605-1315
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Country | US
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Telephone | 312-341-4153
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Fax | 312-341-3522
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Provider Business Mailing Address
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Address Line | 4350 N BROADWAY ST APT 501
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City | CHICAGO
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State | IL
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Zip | 60613-4855
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Country | US
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Telephone | 515-890-2995
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 100602039
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License Number State | IL
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