Provider Demographics
NPI:1861699530
Name:HANNAM, AMI TALATI (MD)
Entity type:Individual
Prefix:DR
First Name:AMI
Middle Name:TALATI
Last Name:HANNAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMI
Other - Middle Name:DELILAH
Other - Last Name:TALATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:10733 165TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8713
Practice Address - Country:US
Practice Address - Phone:708-957-7468
Practice Address - Fax:708-957-7471
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-117880207K00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC036114880Medicaid
ILF401092725OtherMEDICARE PTAN