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NPI Code Detail

MEDICARE: LAURA J HANAHAN M.D.

MEDICARE: LAURA J HANAHAN 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
12085P0229XPediatric Radiology PhysicianDR.0052267CO
22085R0202XDiagnostic Radiology Physician2010038689MO
32085R0202XDiagnostic Radiology PhysicianG8606TX
42085R0202XDiagnostic Radiology PhysicianG174927CA
52085P0229XPediatric Radiology PhysicianG174927CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578566972
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA J HANAHAN M.D.
Provider Business Mailing Address
First Line : PO BOX 776879
Second Line :
City : CHICAGO
State : IL
Zip : 60677-6879
Country : US
Telephone Number : 502-588-9490
Fax Number : 502-272-5116
Provider Business Practice Location Address
First Line : 5655 HUDSON DR STE 210
Second Line :
City : HUDSON
State : OH
Zip : 44236-4455
Country : US
Telephone Number : 330-655-1869
Fax Number : 330-655-3828
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 04/24/2024

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Directions to “ LAURA J HANAHAN M.D.” Practice Location

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