Basic Information
| Provider Information | |||||||||
| NPI: | 1023006806 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANNA | ||||||||
| FirstName: | ENAM | ||||||||
| MiddleName: | BEHNAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 LAPEER AVE | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486071208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897596464 | ||||||||
| FaxNumber: | 9893998233 | ||||||||
| Practice Location | |||||||||
| Address1: | 1522 JANES AVE | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486011819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897550316 | ||||||||
| FaxNumber: | 9897550956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 10/04/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301064323 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080G310660 | 01 | MI | PPO TRUST | OTHER | 1023006806 | 01 | MI | MOLINA HEALTHCARE OF MICHIGAN | OTHER | 381908328 | 01 | MI | PRIORITY HEALTH | OTHER | 080G310660 | 01 | MI | BCN COMMERCIAL | OTHER | 080G310660 | 01 | MI | BLUE PREFERRED PLUS BPP | OTHER | 381908328 | 01 | HCAP | OTHER | 080G310660 | 01 | MI | MEDICARE PLUS BLUE PPO | OTHER | 30341 | 01 | MI | HEALTH PLAN OF MICHIGAN | OTHER | 1010150 | 01 | HEALTH ADVANTAGE PPO | OTHER | 381908328 | 01 | TRICARE | OTHER | 1023006806 | 05 | MI | MEDICAID | 080G310660 | 01 | MI | BCBS TRADITIONAL | OTHER | 0983112 | 01 | MI | HEALTHPLUS | OTHER | 103 | 01 | MI | COMMUNITY CHOICE | OTHER | 381908328 | 01 | PPOM | OTHER | 1010150 | 01 | MCLAREN HEALTH PLAN | OTHER | 108734 | 01 | MI | GREAT LAKES HEALTH PLAN OF MICHIGAN | OTHER | 5836577 | 01 | AETNA | OTHER |