MEDICARE: DR. KIM W HAMMERBERG M.D.

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	207X00000X	Orthopaedic Surgery Physician	036-058222	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	DA4902	OTHER	IL	RR MEDICARE PTAN NUMBER
5	P00408628	OTHER	IL	RR MEDICARE PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1633878	OTHER	IL	BCBS ILLINOIS
2	4316748	OTHER		AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912925165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIM W HAMMERBERG M.D.

Provider Business Mailing Address
First Line	:	P. O. BOX 8500, LOCKBOX 7642
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-7642
Country	:	US
Telephone Number	:	813-281-8115
Fax Number	:	813-281-8656

Provider Business Practice Location Address
First Line	:	2211 N. OAK PARK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60707-3392
Country	:	US
Telephone Number	:	773-622-5400
Fax Number	:	773-385-5488

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	12/19/2012

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