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General NPI Number Information
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NPI Number | 1972847994
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Entity Type | Individual
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Provider Name | PATRICK ALAN HANSMA D.O.
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Gender | Male
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 11001 CEDAR AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-3022
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Country | US
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Telephone | 216-721-5610
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Fax |
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Provider Business Mailing Address
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Address Line | 22774 LISCOMB AVE
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City | EASTPOINTE
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State | MI
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Zip | 48021-4113
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Country | US
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Telephone | 616-485-1255
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 5101019289
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License Number State | MI
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