=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528059318
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK L HAMMEL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2005
-----------------------------------------------------
Last Update Date | 09/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32430 EVERGREEN RD
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48025-2808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-217-4510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32430 EVERGREEN RD
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48025-2808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-217-4510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 4301036133
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------