Individual
MR. MICHAEL HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CST
Contact information
Practice address
1604 VISA DR, STE 1, NORMAL, IL 61761
(309) 846-4716
(309) 454-7348
Mailing address
1604 VISA DR, STE 1, NORMAL, IL 61761
(309) 846-4716
(309) 454-7348
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
238.000.498
IL
Other
Enumeration date
09/23/2016
Last updated
09/23/2016
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