Provider Demographics
NPI:1386656213
Name:HAMSTRA, DANIEL ALLAN (MD PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALLAN
Last Name:HAMSTRA
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 TOWN CENTER DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1744
Mailing Address - Country:US
Mailing Address - Phone:248-585-8265
Mailing Address - Fax:248-585-8266
Practice Address - Street 1:18181 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-5032
Practice Address - Country:US
Practice Address - Phone:313-593-3733
Practice Address - Fax:248-982-5425
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010777512085R0001X
TXQ44212085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX346767201Medicaid
TXP01667433OtherRAILROAD
TX346767202Medicaid
TX417948YTU3Medicare PIN
TX417948YM09Medicare PIN