MEDICARE: RACHEL 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	207Q00000X	Family Medicine Physician	036150946	IL

General Provider Information

NPI Number	:	1245687425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL HANSEN MD

Provider Business Mailing Address
First Line	:	PO BOX 78866
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53278-8866
Country	:	US
Telephone Number	:	779-696-7150
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 W BLACKHAWK DR
Second Line	:
City	:	BYRON
State	:	IL
Zip	:	61010-8988
Country	:	US
Telephone Number	:	779-696-1300
Fax Number	:

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

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	03/18/2021

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