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General NPI Number Information
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NPI Number | 1235167149
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Entity Type | Individual
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Provider Name | LARA HAMMOND MD
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Gender | Female
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 305 W JACKSON ST STE 303
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City | CARBONDALE
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State | IL
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Zip | 62901-1474
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Country | US
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Telephone | 618-351-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 7900 N MILWAUKEE AVE SUITE 17
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City | NILES
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State | IL
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Zip | 60714-3159
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Country | US
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Telephone | 847-470-0297
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Fax | 847-470-0302
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 2016-02055
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 036-116220
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License Number State | IL
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