Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2018009560 | MO |
N | 111NI0900X | Internist | 2018009560 | MO |
Y | 207RH0000X | Hematologist | 125.074024 | IL |
NPI | 1376908913 |
---|---|
Provider Name | Dr. Abdul Hannan |
First Address | Springfield, IL 62794-9678 |
Second Address | Springfield, IL 62702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2015 |
Last Update Date | 19/08/2019 |