MEDICARE: THANAA AL-HAMAD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	4301064044	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356317556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THANAA AL-HAMAD MD

Provider Business Mailing Address
First Line	:	PO BOX 610228
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48061-0228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 STONE ST
Second Line	:	SUITE 3
City	:	PORT HURON
State	:	MI
Zip	:	48060-3563
Country	:	US
Telephone Number	:	810-982-8742
Fax Number	:	810-984-8291

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	07/08/2007

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