Provider Demographics
NPI:1154375608
Name:HANISCH, DENISE S (MD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:S
Last Name:HANISCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 STONE PARK BLVD
Mailing Address - Street 2:UNITYPOINT HEALTH-ST. LUKE'S
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3734
Mailing Address - Country:US
Mailing Address - Phone:712-279-3203
Mailing Address - Fax:712-279-4995
Practice Address - Street 1:2720 STONE PARK BLVD
Practice Address - Street 2:UNITYPOINT HEALTH-ST. LUKE'S
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3734
Practice Address - Country:US
Practice Address - Phone:712-279-3203
Practice Address - Fax:712-279-4995
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-30906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G20517Medicare UPIN