Provider Demographics
NPI:1457400954
Name:HAMES, DOUGLAS GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:GREGORY
Last Name:HAMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 SUNNINGDALE DR
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1672
Mailing Address - Country:US
Mailing Address - Phone:313-882-6611
Mailing Address - Fax:
Practice Address - Street 1:22850 KELLY RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2028
Practice Address - Country:US
Practice Address - Phone:586-774-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDH040884207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0503285OtherBCBS
MI2101011Medicaid
MI4301040884OtherBC
MI040884OtherPRIVATE INS
MIA75981Medicare UPIN
MI0503285OtherBCBS