1013972926 NPI number — WILLIAM FRANCIS HANAVAN M.D.

Table of content: WILLIAM FRANCIS HANAVAN M.D. (NPI 1013972926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013972926 NPI number — WILLIAM FRANCIS HANAVAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANAVAN
Provider First Name:
WILLIAM
Provider Middle Name:
FRANCIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013972926
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3304 COOLEY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTAGE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49024-7430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-349-2266
Provider Business Mailing Address Fax Number:
269-349-0792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3304 COOLEY CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTAGE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49024-7430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-349-2266
Provider Business Practice Location Address Fax Number:
269-349-0792
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  WH053362 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100C910690 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0P56360001 . This is a "MEDICARE ID 04/25/2008 AND AFTER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1013972926 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10417171759 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 383309299134 . This is a "CARESOURCE MEDICAID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 100C914640 . This is a "BCBS 04/25/2008 AND AFTER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1851569958 . This is a "NPI 04/25/2008 AND AFTER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1013972926 . This is a "NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: WH053362 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0M92920006 . This is a "MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 101173 . This is a "GREAT LAKES HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1417961137 . This is a "BCBSM - BRONSON" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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