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Individual

DR. MARK CHARLES HANNIBAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D., PH.D.

Contact information

Practice address
1500 E MEDICAL CENTER DR, 6TH FLOOR MOTT CHILDRENS HOSPITAL, ANN ARBOR, MI 48109-4259
(734) 936-4185
Mailing address
3621 S STATE ST, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047

Taxonomy

Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
4301099786
MI
207SG0201X
Clinical Genetics (M.D.) Physician
MD00037850
WA
208000000X
Pediatrics Physician
Primary
4301099786
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3199
INTERNAL ID-MOTOR VEHICLE ID
05
8246647
WA
Enumeration date
10/13/2006
Last updated
09/13/2012
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