Provider Demographics
NPI:1093715351
Name:HAMBEL, MICHAEL R (MSPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:HAMBEL
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 TRI PARK WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-1652
Mailing Address - Country:US
Mailing Address - Phone:920-830-6697
Mailing Address - Fax:920-830-6707
Practice Address - Street 1:524 COUNTY ROAD 34 EAST
Practice Address - Street 2:
Practice Address - City:DODGE CENTER
Practice Address - State:MN
Practice Address - Zip Code:55927
Practice Address - Country:US
Practice Address - Phone:920-858-7427
Practice Address - Fax:920-830-6707
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10443-024225100000X
MN6959225100000X
IA004288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI117378OtherSECURITY HEALTH PLAN
WI001286020OtherMEDICARE
WI64-07697OtherMEDICA
WI001986652OtherMEDICARE
WI40458900Medicaid
Q45260Medicare UPIN