MEDICARE: PAMELA J HACKL DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5101011928	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134125024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA J HACKL DO

Provider Business Mailing Address
First Line	:	7443 JACKMAN RD
Second Line	:
City	:	TEMPERANCE
State	:	MI
Zip	:	48182-9223
Country	:	US
Telephone Number	:	734-850-0100
Fax Number	:	888-491-3525

Provider Business Practice Location Address
First Line	:	7443 JACKMAN RD
Second Line	:
City	:	TEMPERANCE
State	:	MI
Zip	:	48182-9223
Country	:	US
Telephone Number	:	734-850-0100
Fax Number	:	734-850-0112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	06/13/2022

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