Healthcare Provider Details

I. General information

NPI: 1700268406
Provider Name (Legal Business Name): NATHANIEL HAMM DPM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 FRONT ST
BEREA OH
44017-1716
US

IV. Provider business mailing address

429 FRONT ST
BEREA OH
44017-1716
US

V. Phone/Fax

Practice location:
  • Phone: 440-243-6660
  • Fax: 844-270-2783
Mailing address:
  • Phone: 440-243-6660
  • Fax: 844-270-2783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.003717
License Number StateOH

VIII. Authorized Official

Name: NATHANIEL ANDREW HAMM
Title or Position: OWNER
Credential: D.P.M.
Phone: 614-325-9460