Basic Information
| Provider Information | |||||||||
| NPI: | 1699805911 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANISH | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | I. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5959 HARRY HINES BLVD STE HP4.102 | ||||||||
| Address2: | MAIL CODE 8567 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752356234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146456682 | ||||||||
| FaxNumber: | 2146456771 | ||||||||
| Practice Location | |||||||||
| Address1: | 5939 HARRY HINES BLVD STE 700 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752356243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146451919 | ||||||||
| FaxNumber: | 2146451903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 08/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204F00000X | R8570 | TX | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 208600000X | R8570 | TX | N | Allopathic & Osteopathic Physicians | Surgery | 204F00000X | D0075219 | MD | Y | Allopathic & Osteopathic Physicians | Transplant Surgery |
ID Information
| ID | Type | State | Issuer | Description | D0075219 | 01 | MD | STATE LICENSE | OTHER | R8570 | 01 | TX | TEXAS STATE LICENSE | OTHER |