Provider Demographics
NPI:1447542634
Name:HANNAH, JOHN BRECKENRIDGE (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRECKENRIDGE
Last Name:HANNAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-4905
Mailing Address - Country:US
Mailing Address - Phone:989-725-9490
Mailing Address - Fax:
Practice Address - Street 1:1000 HANOVER ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-4905
Practice Address - Country:US
Practice Address - Phone:989-725-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301027832208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice