Individual
DR. SIDNEY J HANISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1A VILLAGE SQUARE SHOP CTR, HAZELWOOD, MO 63042-1817
(314) 731-5656
(314) 731-3215
Mailing address
1A VILLAGE SQUARE SHOP CTR, HAZELWOOD, MO 63042-1817
(314) 731-5656
(314) 731-3215
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MDR8613
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006005882
BLUE CROSS BLUE SHIELD
IL
01
—
118695
HEALTHLINK
—
Enumeration date
12/13/2006
Last updated
03/18/2008
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