MEDICARE: DR. PATRICK ALAN HANSMA D.O.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	5101019289	MI

General Provider Information

NPI Number	:	1972847994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK ALAN HANSMA D.O.

Provider Business Mailing Address
First Line	:	22774 LISCOMB AVE
Second Line	:
City	:	EASTPOINTE
State	:	MI
Zip	:	48021-4113
Country	:	US
Telephone Number	:	616-485-1255
Fax Number	:

Provider Business Practice Location Address
First Line	:	11001 CEDAR AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-3022
Country	:	US
Telephone Number	:	216-721-5610
Fax Number	:

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

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	03/07/2023

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