MEDICARE: KENNETH C. HANSON JR. 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	207P00000X	Emergency Medicine Physician	01054195A	IN
2	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	036-141304	IL
3	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	65793-20	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00775286	OTHER	IN	RAILROAD MEDICARE
9	P00841040	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HANSOKEN	OTHER	WI	MERCYCARE INSURANCE
2	000000198747	OTHER	IN	BLUE CROSS/BLUE SHIELD
3	000000640498	OTHER	IN	BC/BS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	000000668240	OTHER	IN	ANTHEM BC/BS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	P00023838	OTHER	IN	RAIL ROAD
10	1295734135	OTHER	WI	BCBSWI

General Provider Information

NPI Number	:	1295734135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH C. HANSON JR. MD

Provider Business Mailing Address
First Line	:	7905 E CURTIS RD
Second Line	:
City	:	FRANKENMUTH
State	:	MI
Zip	:	48734-9583
Country	:	US
Telephone Number	:
Fax Number	:	262-245-2248

Provider Business Practice Location Address
First Line	:	900 COOPER AVE
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48602-5182
Country	:	US
Telephone Number	:	989-583-6521
Fax Number	:

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	03/26/2021

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