Provider Demographics
NPI:1568637643
Name:ROBERT L HAMILTON DO PC
Entity Type:Organization
Organization Name:ROBERT L HAMILTON DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-695-1122
Mailing Address - Street 1:6011 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8538
Mailing Address - Country:US
Mailing Address - Phone:810-695-1122
Mailing Address - Fax:810-695-5711
Practice Address - Street 1:6011 PORTER RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8538
Practice Address - Country:US
Practice Address - Phone:810-695-1122
Practice Address - Fax:810-695-5711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2122100Medicaid
MI5250231Medicare PIN