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General NPI Number Information
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NPI Number | 1699189241
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Entity Type | Individual
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Provider Name | KYLE HAMMERMEISTER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/11/2014
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Last Update Date | 11/11/2018
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Provider Practice Location Address
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Address Line | 3601 W 13 MILE RD
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City | ROYAL OAK
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State | MI
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Zip | 48073-6712
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Country | US
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Telephone | 248-898-2001
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Fax |
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Provider Business Mailing Address
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Address Line | 6795 GREENWOOD DR
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City | BEAUMONT
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State | TX
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Zip | 77706-4216
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Country | US
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Telephone | 269-921-3267
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Fax |
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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 | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 4301105051
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 4301105051
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | R1039
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License Number State | TX
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