Provider Demographics
NPI:1235291766
Name:HAMMERMAN, KENNETH W (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:W
Last Name:HAMMERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MALTON ST
Mailing Address - Street 2:STE 4
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-2001
Mailing Address - Country:US
Mailing Address - Phone:906-475-7838
Mailing Address - Fax:906-486-6898
Practice Address - Street 1:100 MALTON ST
Practice Address - Street 2:STE 4
Practice Address - City:NEGAUNEE
Practice Address - State:MI
Practice Address - Zip Code:49866-2001
Practice Address - Country:US
Practice Address - Phone:906-475-7838
Practice Address - Fax:906-486-6898
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014669174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIKH014669OtherBCBS LICENSE
MIP00203790OtherRRMEDICARE
MIH98345Medicare UPIN