Provider Demographics
NPI:1659359768
Name:PHAM, HAI T (DPM)
Entity Type:Individual
Prefix:DR
First Name:HAI
Middle Name:T
Last Name:PHAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1221 S. WATER STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240
Mailing Address - Country:US
Mailing Address - Phone:330-474-0500
Mailing Address - Fax:330-474-0501
Practice Address - Street 1:1221 S. WATER STREET
Practice Address - Street 2:SUITE A
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240
Practice Address - Country:US
Practice Address - Phone:330-474-0500
Practice Address - Fax:330-474-0501
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2011-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-3280 -P213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2415247Medicaid
1659359768OtherNPI
OH4103782Medicare ID - Type Unspecified
OH4874780001Medicare NSC
OH2415247Medicaid