Individual
KEVIN HANNEKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1020 SANSOM ST STE 1651B, PHILADELPHIA, PA 19107
(215) 955-9837
Mailing address
1020 SANSOM ST STE 1651B, PHILADELPHIA, PA 19107-5002
(215) 955-9837
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MT215116
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/19/2018
Last updated
05/21/2018
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