Provider Demographics
NPI:1407831795
Name:K. HAMAMDJIAN MD PC
Entity Type:Organization
Organization Name:K. HAMAMDJIAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHATCHADOUR
Authorized Official - Middle Name:WAHAN
Authorized Official - Last Name:HAMAMDJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-642-1389
Mailing Address - Street 1:104 MANORWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2133
Mailing Address - Country:US
Mailing Address - Phone:248-642-1389
Mailing Address - Fax:248-353-0883
Practice Address - Street 1:27177 LAHSER RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-4714
Practice Address - Country:US
Practice Address - Phone:248-353-6580
Practice Address - Fax:248-353-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037656174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4557191OtherAETNA INSURANCE
MI280F339180OtherBLUE CROSS BLUE SHIELD MI
MI4137828Medicaid
MI128807OtherCARE CHOICE HMO
MI2440249001OtherCIGNA INS.
MI354121OtherUNITED HEALTH CARE
MI128807OtherPREFERRED CHOICE PPO
MI280000118OtherRAILROAD MEDICARE
MIA78356OtherHEALTH ALLIANCE PLAN
MI0M77660Medicare PIN
MI2440249001OtherCIGNA INS.