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General NPI Number Information
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NPI Number | 1891723185
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Entity Type | Individual
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Provider Name | GREG HACKEL DO
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 05/08/2013
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Provider Practice Location Address
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Address Line | 9100 BROMBACH ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3473
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Country | US
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Telephone | 313-972-9001
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Fax | 313-972-9038
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Provider Business Mailing Address
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Address Line | 2450 MIDVALE ST
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City | BIRMINGHAM
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State | MI
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Zip | 48009-1521
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Country | US
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Telephone | 313-399-9803
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Fax | 313-972-9038
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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 | 5101011844
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License Number State | MI
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