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NPI Code Detail

MEDICARE: BROOK G. HANSON PA-C

MEDICARE: BROOK G. HANSON PA-C
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
1363A00000XPhysician Assistant375277-1206UT
2363AS0400XSurgical Physician AssistantPA60747580WA
3363A00000XPhysician Assistant5601012618MI

General Provider Information

NPI Number : 1932273687
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOK G. HANSON PA-C
Provider Business Mailing Address
First Line : 41800 W 11 MILE RD STE 109
Second Line :
City : NOVI
State : MI
Zip : 48375-1818
Country : US
Telephone Number : 248-660-1220
Fax Number :
Provider Business Practice Location Address
First Line : 900 S BEACON BLVD
Second Line :
City : GRAND HAVEN
State : MI
Zip : 49417-2146
Country : US
Telephone Number : 616-296-7300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2006
Last Update Date : 01/15/2025

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Directions to “ BROOK G. HANSON PA-C” Practice Location

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