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General NPI Number Information
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NPI Number | 1629593272
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Entity Type | Organization
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Legal Business Name | PAUL L. HANNAH, M.D. , M.S. LTD
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Dates
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Enumeration Date | 08/04/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3787 GRANT ST
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City | GARY
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State | IN
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Zip | 46408-2142
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Country | US
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Telephone | 219-981-4800
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Fax | 219-981-4805
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Provider Business Mailing Address
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Address Line | 3787 GRANT ST
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City | GARY
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State | IN
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Zip | 46408-2142
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Country | US
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Telephone | 219-981-4800
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Fax | 219-981-4805
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Authorized Official
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Title or Position | CEO
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Name | PAUL L. HANNAH
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Credential | MD, M.S, LTD
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Telephone | 219-981-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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