MEDICARE: BARBARA ANN HANNAH M.D.

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	207V00000X	Obstetrics & Gynecology Physician	BH063985	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0827291	OTHER	MI	BLUE CROSS BLUE SHIELD MI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396780417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA ANN HANNAH M.D.

Provider Business Mailing Address
First Line	:	14184 LONGACRE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48227-1357
Country	:	US
Telephone Number	:	313-388-4247
Fax Number	:	313-388-4827

Provider Business Practice Location Address
First Line	:	25050 OUTER DR
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-1297
Country	:	US
Telephone Number	:	313-388-4247
Fax Number	:	313-388-4827

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	02/28/2008

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