Provider Demographics
NPI:1619929486
Name:HAM, ROBERT E
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:HAM
Suffix:
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 1:23450 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-8702
Mailing Address - Country:US
Mailing Address - Phone:913-764-7788
Mailing Address - Fax:913-764-6088
Practice Address - Street 1:23450 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-8702
Practice Address - Country:US
Practice Address - Phone:913-764-7788
Practice Address - Fax:913-764-6088
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0421907207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100155390AMedicaid
KS0332794DMedicare PIN
KS100155390AMedicaid