Provider Demographics
NPI:1407854003
Name:HAMMER, TERI LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:TERI
Middle Name:LYNN
Last Name:HAMMER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20867 MACK AVE
Mailing Address - Street 2:STE 7
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1392
Mailing Address - Country:US
Mailing Address - Phone:313-882-8070
Mailing Address - Fax:313-882-8413
Practice Address - Street 1:20867 MACK AVE
Practice Address - Street 2:STE 7
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1392
Practice Address - Country:US
Practice Address - Phone:313-882-8070
Practice Address - Fax:313-882-8413
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITH015883204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI201894790OtherTAX ID
MI1258211835OtherBLUE CROSS
G35906Medicare UPIN
MI201894790OtherTAX ID