Provider Demographics
NPI:1063157865
Name:SAM R. HAMBURG, PH.D., P.C.
Entity type:Organization
Organization Name:SAM R. HAMBURG, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:HAMBURG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-485-0161
Mailing Address - Street 1:8 S MICHIGAN AVE STE 1507
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-3364
Mailing Address - Country:US
Mailing Address - Phone:312-485-0161
Mailing Address - Fax:
Practice Address - Street 1:8 S MICHIGAN AVE STE 1507
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3364
Practice Address - Country:US
Practice Address - Phone:312-485-0161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health