Provider Demographics
NPI:1366804569
Name:DEIRAWAN, HANY (MD)
Entity type:Individual
Prefix:
First Name:HANY
Middle Name:
Last Name:DEIRAWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22720 MICHIGAN AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2035
Mailing Address - Country:US
Mailing Address - Phone:313-355-4616
Mailing Address - Fax:
Practice Address - Street 1:22720 MICHIGAN AVE STE 301
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2035
Practice Address - Country:US
Practice Address - Phone:313-551-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-26
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315075625207NS0135X, 207ZP0101X, 207N00000X, 207ND0101X, 208600000X
IL036.172063207ZP0101X, 207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery