Healthcare Provider Details

I. General information

NPI: 1528264041
Provider Name (Legal Business Name): MARILYN S HAMER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 LIVERNOIS RD DEPT OF
TROY MI
48083-1214
US

IV. Provider business mailing address

2825 LIVERNOIS RD DEPT OF
TROY MI
48083-1214
US

V. Phone/Fax

Practice location:
  • Phone: 313-874-4907
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301404021
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301404021
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: