Basic Information
| Provider Information | |||||||||
| NPI: | 1609035252 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | HANNAWA | ||||||||
| FirstName: | KEVIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3264N EVERGREEN NEDR | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495259746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163637339 | ||||||||
| FaxNumber: | 6163615828 | ||||||||
| Practice Location | |||||||||
| Address1: | 5333 MCAULEY DR | ||||||||
| Address2: | SUITE 2111 | ||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481971014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347125001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2008 | ||||||||
| LastUpdateDate: | 09/08/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | 4301092277 | MI | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0202X | 4301092277 | MI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.