Healthcare Provider Details

I. General information

NPI: 1730156563
Provider Name (Legal Business Name): ABRAHAM JOSEPH HAMMELL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 S MARSHALL ST
CALEDONIA MN
55921-1331
US

IV. Provider business mailing address

424 S MARSHALL ST
CALEDONIA MN
55921-1331
US

V. Phone/Fax

Practice location:
  • Phone: 630-679-5879
  • Fax: 507-724-1213
Mailing address:
  • Phone: 630-679-5879
  • Fax: 507-724-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOP00001875
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number50512
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: