Individual
HANY J JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1661 HOLLAND RD STE 100, MAUMEE, OH 43537-4206
(419) 794-1105
(419) 794-1106
Mailing address
1661 HOLLAND RD STE 100, MAUMEE, OH 43537-4206
(419) 794-1105
(419) 794-1106
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
01071855A
IN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
35-05-6351 K
OH
207RP1001X
Pulmonary Disease Physician
01071855A
IN
207RP1001X
Pulmonary Disease Physician
35-05-6351K
OH
207RS0012X
Sleep Medicine (Internal Medicine) Physician
35056351
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200823690
—
IN
01
—
290009694
MEDICARE RAILROAD
OH
05
—
692684
—
OH
01
—
P01202311
RR MEDICARE
IN
Enumeration date
11/09/2005
Last updated
08/03/2022
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