MEDICARE: DR. MICHAEL R HANSEN D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	PO0002819	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	65660	OTHER	FL	BCBS FL PROVIDER NUMBER

General Provider Information

NPI Number	:	1386785426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL R HANSEN D.P.M.

Provider Business Mailing Address
First Line	:	1956 41ST AVE STE C
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-2561
Country	:	US
Telephone Number	:	772-567-3338
Fax Number	:	772-567-6397

Provider Business Practice Location Address
First Line	:	1956 41ST AVE STE C
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-2561
Country	:	US
Telephone Number	:	772-567-3338
Fax Number	:	772-567-6397

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

Provider Enumeration Date	:	02/10/2007
Last Update Date	:	07/08/2007

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