Healthcare Provider Details

I. General information

NPI: 1063078558
Provider Name (Legal Business Name): MIRIAM HAMAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W MICHIGAN AVE
YPSILANTI MI
48197-5450
US

IV. Provider business mailing address

301 W MICHIGAN AVE
YPSILANTI MI
48197-5450
US

V. Phone/Fax

Practice location:
  • Phone: 734-221-5440
  • Fax:
Mailing address:
  • Phone: 734-221-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704389389
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: