Healthcare Provider Details

I. General information

NPI: 1306030036
Provider Name (Legal Business Name): PAMELA J. HACKL, D.O., PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7443 JACKMAN RD
TEMPERANCE MI
48182-9223
US

IV. Provider business mailing address

7443 JACKMAN RD
TEMPERANCE MI
48182-9223
US

V. Phone/Fax

Practice location:
  • Phone: 734-850-0100
  • Fax: 734-850-0112
Mailing address:
  • Phone: 734-850-0100
  • Fax: 888-491-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101011928
License Number StateMI

VIII. Authorized Official

Name: PAMELA J. HACKL
Title or Position: OWNER
Credential: D.O.
Phone: 734-850-0100