Provider Demographics
NPI:1043336852
Name:HANNA, MICHAEL JOSEPH (MSED, ATC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:HANNA
Suffix:
Gender:M
Credentials:MSED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 N BROADWAY ST APT 501
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4855
Mailing Address - Country:US
Mailing Address - Phone:515-890-2995
Mailing Address - Fax:
Practice Address - Street 1:430 S MICHIGAN AVE
Practice Address - Street 2:RM 362
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1315
Practice Address - Country:US
Practice Address - Phone:312-341-4153
Practice Address - Fax:312-341-3522
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1006020392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL100602039OtherATC