Provider Demographics
NPI:1902996341
Name:HANNA, GHADA MAGDY (MD)
Entity type:Individual
Prefix:
First Name:GHADA
Middle Name:MAGDY
Last Name:HANNA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3472
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1050 W UNIVERSITY DR STE 3
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1877
Practice Address - Country:US
Practice Address - Phone:248-650-1984
Practice Address - Fax:248-650-1994
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087002208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E031600OtherBCBSM GROUP
MI700E031600OtherBCBSM GROUP
OP26960Medicare PIN
MIMI3996008Medicare PIN