Provider Demographics
NPI:1588864532
Name:HATTAN, MICHAEL J (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:HATTAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:355 PLACENTIA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3311
Mailing Address - Country:US
Mailing Address - Phone:949-650-1900
Mailing Address - Fax:949-650-1902
Practice Address - Street 1:355 PLACENTIA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3311
Practice Address - Country:US
Practice Address - Phone:949-650-1900
Practice Address - Fax:949-650-1902
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE4733213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4733OtherLICENSE NUMBER
CA6207730001Medicare NSC
CABK002Medicare PIN