Provider Demographics
NPI:1326153537
Name:HACKELMAN, RONALD A (DPM)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:A
Last Name:HACKELMAN
Suffix:
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 1:29264 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331
Mailing Address - Country:US
Mailing Address - Phone:248-488-1959
Mailing Address - Fax:248-488-1048
Practice Address - Street 1:634 CHENE STREET
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207
Practice Address - Country:US
Practice Address - Phone:313-259-2210
Practice Address - Fax:248-488-1048
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI001370213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1773251Medicaid
5825164Medicare ID - Type Unspecified
MI1773251Medicaid