MEDICARE: ENAM BEHNAM HANNA MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4301064323	MI

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	080G310660	OTHER	MI	MEDICARE PLUS BLUE PPO

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080G310660	OTHER	MI	PPO TRUST
2	1023006806	OTHER	MI	MOLINA HEALTHCARE OF MICHIGAN
3	381908328	OTHER	MI	PRIORITY HEALTH
4	080G310660	OTHER	MI	BCN COMMERCIAL
5	080G310660	OTHER	MI	BLUE PREFERRED PLUS BPP
6	381908328	OTHER		HCAP
8	30341	OTHER	MI	HEALTH PLAN OF MICHIGAN
9	1010150	OTHER		HEALTH ADVANTAGE PPO
10	381908328	OTHER		TRICARE
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	080G310660	OTHER	MI	BCBS TRADITIONAL
13	0983112	OTHER	MI	HEALTHPLUS
14	103	OTHER	MI	COMMUNITY CHOICE
15	381908328	OTHER		PPOM
16	1010150	OTHER		MCLAREN HEALTH PLAN
17	108734	OTHER	MI	GREAT LAKES HEALTH PLAN OF MICHIGAN
18	5836577	OTHER		AETNA

NPI Number	:	1023006806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENAM BEHNAM HANNA MD

Provider Business Mailing Address
First Line	:	501 LAPEER AVE
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48607-1208
Country	:	US
Telephone Number	:	989-759-6464
Fax Number	:	989-399-8233

Provider Business Practice Location Address
First Line	:	1522 JANES AVE
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48601-1819
Country	:	US
Telephone Number	:	989-755-0316
Fax Number	:	989-755-0956

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	10/04/2011