Provider Demographics
NPI:1467145847
Name:HAM, DOUG III
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:
Last Name:HAM
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8045 SHIELD RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-9721
Mailing Address - Country:US
Mailing Address - Phone:989-737-2913
Mailing Address - Fax:
Practice Address - Street 1:8045 SHIELD RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-9721
Practice Address - Country:US
Practice Address - Phone:989-737-2913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program