Provider Demographics
NPI:1053832832
Name:HAM, MICHAEL HANSOL JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HANSOL
Last Name:HAM
Suffix:JR
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 1:1831 E QUEEN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-2019
Mailing Address - Country:US
Mailing Address - Phone:480-917-2300
Mailing Address - Fax:
Practice Address - Street 1:1831 E QUEEN CREEK RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-2019
Practice Address - Country:US
Practice Address - Phone:480-917-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006827213ES0103X
390200000X
AZPOD001013213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program