Healthcare Provider Details

I. General information

NPI: 1053832832
Provider Name (Legal Business Name): MICHAEL HANSOL HAM JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 COLBY ST STE 101104
BERKELEY CA
94705-2083
US

IV. Provider business mailing address

3000 COLBY ST STE 101104
BERKELEY CA
94705-2083
US

V. Phone/Fax

Practice location:
  • Phone: 510-849-3800
  • Fax:
Mailing address:
  • Phone: 510-849-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6198
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD001013
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006827
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: