MEDICARE: NANCY C HAN M.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	40472	KY
2	208600000X	Surgery Physician	01067600A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215962253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY C HAN M.D.

Provider Business Mailing Address
First Line	:	5215 HOLY CROSS PKWY
Second Line	:
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-1469
Country	:	US
Telephone Number	:	574-335-8707
Fax Number	:	574-335-0741

Provider Business Practice Location Address
First Line	:	1919 LAKE AVE STE 104
Second Line	:
City	:	PLYMOUTH
State	:	IN
Zip	:	46563-7830
Country	:	US
Telephone Number	:	574-948-5170
Fax Number	:	574-948-5498

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	04/01/2025

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1871548438 — SAMUEL B VANLANDINGHAM M.D.
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1821037532 — ROD STEPHEN KUBLEY M.D.
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1861411209 — JANICE ANN BALDWIN CNM
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Directions to “ NANCY C HAN M.D.” Practice Location

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