MEDICARE: DR. EWA M HANSEN MD

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	208000000X	Pediatrics Physician	35045807	OH
2	208000000X	Pediatrics Physician	4301061029	MI

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235132275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EWA M HANSEN MD

Provider Business Mailing Address
First Line	:	3740 W SYLVANIA AVE
Second Line	:	STE 250
City	:	TOLEDO
State	:	OH
Zip	:	43623-4493
Country	:	US
Telephone Number	:	419-473-6670
Fax Number	:	419-473-9959

Provider Business Practice Location Address
First Line	:	3740 W SYLVANIA AVE
Second Line	:	STE 250
City	:	TOLEDO
State	:	OH
Zip	:	43623-4493
Country	:	US
Telephone Number	:	419-473-6670
Fax Number	:	419-473-9959

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	02/10/2017

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