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General NPI Number Information
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NPI Number | 1821100389
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Entity Type | Organization
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Legal Business Name | HAN M HANAFY MDSC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 10/15/2010
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Provider Practice Location Address
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Address Line | 404 N COMMERCIAL ST
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City | HARRISBURG
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State | IL
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Zip | 62946-3307
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Country | US
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Telephone | 618-252-7424
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Fax | 618-252-0737
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Provider Business Mailing Address
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Address Line | PO BOX 783
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City | HARRISBURG
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State | IL
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Zip | 62946-0783
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Country | US
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Telephone | 618-252-7424
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Fax | 618-252-0737
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Authorized Official
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Title or Position | OWNER
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Name | HAN M HANAFY
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Credential | MDSC
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Telephone | 61825274724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 36-45949
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License Number State | IL
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