MEDICARE: STEPHEN E HANNAN 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	207RP1001X	Pulmonary Disease Physician	ME0046939	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P01319835	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	05917	OTHER	FL	BCBS OF FL
3	4237270	OTHER	FL	AETNA
5	P203161	OTHER	FL	OPTIMUM
6	205792	OTHER	FL	AVMED
7	7198660	OTHER	FL	CIGNA
8	P305703	OTHER	FL	FREEDOM

General Provider Information

NPI Number	:	1467470054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN E HANNAN M.D.

Provider Business Mailing Address
First Line	:	2234 COLONIAL BLVD
Second Line	:	ATTN: PAYER CONTRACTING & RELATIONS
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1412
Country	:	US
Telephone Number	:	239-931-7342
Fax Number	:	239-931-7385

Provider Business Practice Location Address
First Line	:	7335 GLADIOLUS DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-5101
Country	:	US
Telephone Number	:	239-985-1925
Fax Number	:	239-321-6044

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/28/2014

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Directions to “ STEPHEN E HANNAN M.D.” Practice Location

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