Individual
SAM HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3900 ST FRANCIS WAY STE 205, LAFAYETTE, IN 47905-4939
(765) 428-2500
Mailing address
3900 ST FRANCIS WAY STE 205, LAFAYETTE, IN 47905-4939
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01054645A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200342990
—
IN
Enumeration date
02/24/2006
Last updated
06/27/2022
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