Provider Demographics
NPI:1154302339
Name:HAM, STEVEN D (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:D
Last Name:HAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name Type:
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Mailing Address - Street 1:3901 BEAUBIEN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2119
Mailing Address - Country:US
Mailing Address - Phone:313-833-4490
Mailing Address - Fax:313-993-8744
Practice Address - Street 1:3901 BEAUBIEN ST FL 2
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-833-4490
Practice Address - Fax:313-993-8744
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007824207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI403984512Medicaid
PD007824OtherCOMMERCIAL-COMMERCIAL NUMBER
700H262190OtherBLUE CROSS-BLUE CROSS
PD007824OtherCHAMPUS-CHAMPUS
700H262190OtherBLUE CROSS-BLUE CROSS
PD007824OtherCOMMERCIAL-COMMERCIAL NUMBER