Basic Information
| Provider Information | |||||||||
| NPI: | 1013206556 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARIANI | ||||||||
| FirstName: | HANNA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SURAWSKA | ||||||||
| OtherFirstName: | HANNA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6308 8TH AVE | ||||||||
| Address2: | ATTN: MEDICAL STAFF OFFICE | ||||||||
| City: | KENOSHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531435031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626563313 | ||||||||
| FaxNumber: | 2626535850 | ||||||||
| Practice Location | |||||||||
| Address1: | 6308 8TH AVE | ||||||||
| Address2: | STE 3070 | ||||||||
| City: | KENOSHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531435031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626563710 | ||||||||
| FaxNumber: | 2626563715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2011 | ||||||||
| LastUpdateDate: | 02/16/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 66687-20 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 13905857 | 01 | WI | CAQH | OTHER | 1013206556 | 05 | WI | MEDICAID | 66687-20 | 01 | WI | WI LICENSE | OTHER |