Provider Demographics
NPI:1992202790
Name:HNATIO, BRYAN ADAM (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:ADAM
Last Name:HNATIO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37719 MARGARETA DR
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2611
Mailing Address - Country:US
Mailing Address - Phone:734-837-2718
Mailing Address - Fax:
Practice Address - Street 1:20901 W 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-1904
Practice Address - Country:US
Practice Address - Phone:313-564-5510
Practice Address - Fax:248-336-9137
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008438363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2626671Medicaid