Provider Demographics
NPI:1053448332
Name:HAMAMDJIAN, KHATCHADOUR (MD)
Entity Type:Individual
Prefix:
First Name:KHATCHADOUR
Middle Name:
Last Name:HAMAMDJIAN
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 1:104 MANORWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2133
Mailing Address - Country:US
Mailing Address - Phone:248-642-1389
Mailing Address - Fax:248-642-1389
Practice Address - Street 1:27177 LAHSER RD
Practice Address - Street 2:SUITE NUMBER 104
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-4714
Practice Address - Country:US
Practice Address - Phone:248-353-6580
Practice Address - Fax:248-353-0883
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2014-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037656208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2806302021OtherBCBSM
MIM77660001Medicare PIN