Basic Information
| Provider Information | |||||||||
| NPI: | 1699020370 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANSEN | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., MSC, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 653 HINMAN AVE APT 2N | ||||||||
| Address2: | |||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602024439 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 225 E. CHICAGO AVENUE, BOX 51, DIVISION OF NEUROLOGY | ||||||||
| Address2: | ANN AND ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3122273550 | ||||||||
| FaxNumber: | 3122279642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2012 | ||||||||
| LastUpdateDate: | 07/18/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | 125-060756 | IL | Y | Hospitals | General Acute Care Hospital | Children |
No ID Information.