Individual
HANNA PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD, MPH
Contact information
Practice address
100 MICHIGAN ST NE RM 8830, GRAND RAPIDS, MI 49503
(616) 459-7258
Mailing address
9961 SIERRA AVE, ATTN: CARDIAC SURGERY, FONTANA, CA 92335
(909) 427-3615
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
4301116177
MI
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
A133676
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/26/2013
Last updated
12/05/2021
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