=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265470348
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONA HANNA MD MPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2006
-----------------------------------------------------
Last Update Date | 11/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ONE HURLEY PLAZA
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48503-5993
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-262-9353
-----------------------------------------------------
Fax | 810-760-0440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 717 ARBOR CT
-----------------------------------------------------
City | BLOOMFIELD HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48304-2801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 4301080229
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------