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NPI Code Detail

MEDICARE: EYAD MICHAEL HANNA MD

MEDICARE: EYAD MICHAEL HANNA 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
12080P0206XPediatric Gastroenterology Physician37301IA
22080P0206XPediatric Gastroenterology Physician036178729IL
3208000000XPediatrics Physician37301IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
170100OTHERIAWELLMARK BCBS

General Provider Information

NPI Number : 1306041660
Entity Type Code : Individual
Provider Name (Legal Business Name) : EYAD MICHAEL HANNA MD
Provider Business Mailing Address
First Line : 420 NE GLEN OAK AVE STE 201
Second Line :
City : PEORIA
State : IL
Zip : 61603-3112
Country : US
Telephone Number : 309-624-2277
Fax Number :
Provider Business Practice Location Address
First Line : 420 NE GLEN OAK AVE STE 201
Second Line :
City : PEORIA
State : IL
Zip : 61603-3112
Country : US
Telephone Number : 309-624-2277
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2007
Last Update Date : 05/13/2026

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Directions to “ EYAD MICHAEL HANNA MD” Practice Location

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