Basic Information
| Provider Information | |||||||||
| NPI: | 1821438185 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANA | ||||||||
| FirstName: | MARIANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 ORLAND SQUARE DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604626522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089145145 | ||||||||
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| Practice Location | |||||||||
| Address1: | 60 ORLAND SQUARE DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089145145 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2013 | ||||||||
| LastUpdateDate: | 07/02/2018 | ||||||||
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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 | 207QS0010X | 036139097 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.