Provider Demographics
NPI:1366558801
Name:HANKENSON, PAUL D (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:HANKENSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 KYLE ST
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-8908
Mailing Address - Country:US
Mailing Address - Phone:517-663-3344
Mailing Address - Fax:517-663-1703
Practice Address - Street 1:1501 KYLE ST
Practice Address - Street 2:
Practice Address - City:EATON RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:48827-8908
Practice Address - Country:US
Practice Address - Phone:517-663-3344
Practice Address - Fax:517-663-1703
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007052207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION14720001Medicare ID - Type Unspecified
MIE26487Medicare UPIN