Basic Information
| Provider Information | |||||||||
| NPI: | 1891784237 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAHN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4120 W MEMORIAL RD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731209322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057483300 | ||||||||
| FaxNumber: | 4057482920 | ||||||||
| Practice Location | |||||||||
| Address1: | 4120 W MEMORIAL RD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731209322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057483300 | ||||||||
| FaxNumber: | 4057482920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2005 | ||||||||
| LastUpdateDate: | 06/23/2008 | ||||||||
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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 | 174400000X | 18431 | OK | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 100131770A | 05 | OK | MEDICAID |