Individual
DR. MICHAEL W HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
916 INDIANA AVE STE 120, PUEBLO, CO 81004-3572
(719) 296-5841
(719) 542-0746
Mailing address
PO BOX 570, PUEBLO, CO 81002-0570
(719) 296-5840
(719) 542-0746
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
27748
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01277482
—
CO
01
—
050051083
RR MEDICARE
—
01
—
CH6461
RR MEDICARE - GROUP
—
01
—
PH18408
BCBS
—
Enumeration date
08/01/2006
Last updated
04/30/2019
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