Provider Demographics
NPI:1154586295
Name:HANSEN, WILHELM GUSTAV (M D)
Entity type:Individual
Prefix:DR
First Name:WILHELM
Middle Name:GUSTAV
Last Name:HANSEN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 HECTOR ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-2037
Mailing Address - Country:US
Mailing Address - Phone:607-273-2643
Mailing Address - Fax:
Practice Address - Street 1:1013 HECTOR ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-2037
Practice Address - Country:US
Practice Address - Phone:607-273-2643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY90793207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine