Provider Demographics
NPI:1366558504
Name:HAMMER, DAVID ALAN (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:HAMMER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MENOMINEE
Mailing Address - State:MI
Mailing Address - Zip Code:49858-1314
Mailing Address - Country:US
Mailing Address - Phone:906-863-5585
Mailing Address - Fax:906-863-8420
Practice Address - Street 1:4320 10TH ST
Practice Address - Street 2:
Practice Address - City:MENOMINEE
Practice Address - State:MI
Practice Address - Zip Code:49858-1314
Practice Address - Country:US
Practice Address - Phone:906-863-5585
Practice Address - Fax:906-863-8420
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001935213E00000X
WI781025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDH001935OtherBC BS OF MI PIN #
WI0001Medicaid
WI090003914OtherWEA PIN #
WI090003914OtherWEA PIN #
MIN94950001Medicare ID - Type UnspecifiedMEDICARE PIN # MICHIGAN
U73088Medicare UPIN