Provider Demographics
NPI:1194101451
Name:HANN, WALTER
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:HANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8281 ARNOLD ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1218
Mailing Address - Country:US
Mailing Address - Phone:313-333-8745
Mailing Address - Fax:
Practice Address - Street 1:8281 ARNOLD ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1218
Practice Address - Country:US
Practice Address - Phone:313-333-8745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-09
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI60318522OtherCLIENT ID NUMBER