Basic Information
| Provider Information | |||||||||
| NPI: | 1437649795 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANEWICH | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 620 SHADOW LANE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023888436 | ||||||||
| FaxNumber: | 7023888431 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 HAWKINS DR | ||||||||
| Address2: | |||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522421009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193564019 | ||||||||
| FaxNumber: | 3193538073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2018 | ||||||||
| LastUpdateDate: | 08/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | DO-05803 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | DO-05803 | IA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | SL1336 | 01 | NV | NEVADA STATE BOARD OF OSTEOPATHIC MEDICINE | OTHER |