Basic Information
| Provider Information | |||||||||
| NPI: | 1801851332 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANAI | ||||||||
| FirstName: | HISHAM | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1839 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337138900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273221054 | ||||||||
| FaxNumber: | 7278217213 | ||||||||
| Practice Location | |||||||||
| Address1: | 5500 DR MARTIN LUTHER KING JR ST N | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337031204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275255500 | ||||||||
| FaxNumber: | 7278217213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 07/01/2019 | ||||||||
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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 | 207Q00000X | ME74438 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 015566000 | 05 | FL | MEDICAID | 42446 | 01 | FL | BLUE CROSS BLUE SHIELD HO | OTHER |