Provider Demographics
NPI:1427107366
Name:HAMILTON, MICHAEL DARRICK (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DARRICK
Last Name:HAMILTON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E NUTWOOD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-2354
Mailing Address - Country:US
Mailing Address - Phone:310-693-0483
Mailing Address - Fax:310-693-0485
Practice Address - Street 1:333 E NUTWOOD ST
Practice Address - Street 2:SUITE B
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-2354
Practice Address - Country:US
Practice Address - Phone:310-693-0483
Practice Address - Fax:310-693-0485
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46284207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G462840Medicaid
CA00G462840Medicaid
CAG46284Medicare ID - Type Unspecified