Provider Demographics
NPI:1902801525
Name:HAHN, JAMES H (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:HAHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 E RUSHOLME ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2467
Mailing Address - Country:US
Mailing Address - Phone:563-421-3122
Mailing Address - Fax:563-421-3129
Practice Address - Street 1:1228 E RUSHOLME ST
Practice Address - Street 2:SUITE 112
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2467
Practice Address - Country:US
Practice Address - Phone:563-421-3122
Practice Address - Fax:563-421-3129
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23423207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA15409OtherIOWA MIDLANDS CHOICE
ILIL 1240003OtherILLINOIS MEDICARE PROVIDER NUMBER
IAP00287447OtherMEDICARE RAILROAD
IA8201954Medicaid
IA39981OtherWELMARK BCBS
IA9201954Medicaid
IA15409OtherIOWA MIDLANDS CHOICE
ILIL$$$$$$$$$Medicaid
IAP00287447OtherMEDICARE RAILROAD
IAI15918Medicare PIN