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General NPI Number Information
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NPI Number | 1851510770
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Entity Type | Individual
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Provider Name | NATHAN EVERETT DERHAMMER M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 2160 S 1ST AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-216-5368
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Fax |
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Provider Business Mailing Address
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Address Line | 444 WASHINGTON BLVD APT 204 UNIT 204
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City | OAK PARK
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State | IL
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Zip | 60302-4060
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Country | US
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Telephone | 708-386-1928
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036115662
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036115662
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 036115662
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License Number State | IL
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