Healthcare Provider Details

I. General information

NPI: 1528059318
Provider Name (Legal Business Name): MARK L HAMMEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32430 EVERGREEN RD
BEVERLY HILLS MI
48025-2808
US

IV. Provider business mailing address

32430 EVERGREEN RD
BEVERLY HILLS MI
48025-2808
US

V. Phone/Fax

Practice location:
  • Phone: 248-217-4510
  • Fax:
Mailing address:
  • Phone: 248-217-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301036133
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: