MEDICARE: HAMMOUD MEDICAL CENTER PC

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	207Q00000X	Family Medicine Physician	4301078769	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	DC4758	OTHER	MI	RAILROAD MEDICARE GROUP

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
2	080H223200	OTHER	MI	BC GROUP
3	080H223200	OTHER	MI	BCN GROUP
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922006048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAMMOUD MEDICAL CENTER PC

Provider Business Mailing Address
First Line	:	PO BOX 77700
Second Line	:	DEPT 77261
City	:	DETROIT
State	:	MI
Zip	:	48277-0700
Country	:	US
Telephone Number	:	313-562-9588
Fax Number	:	313-562-9589

Provider Business Practice Location Address
First Line	:	22146 FORD RD
Second Line	:	#3
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2419
Country	:	US
Telephone Number	:	313-562-9588
Fax Number	:	313-562-9589

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. RICHARD HAMMOUD
Credential	:	MD
Telephone Number	:	313-562-9588

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	04/29/2009

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Directions to “HAMMOUD MEDICAL CENTER PC ” Practice Location

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