Provider Demographics
NPI:1851307961
Name:HAMACHER, DAVID LAWRENCE (MDFACOG)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:HAMACHER
Suffix:
Gender:M
Credentials:MDFACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7616 SUMMITT
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MI
Mailing Address - Zip Code:49837
Mailing Address - Country:US
Mailing Address - Phone:906-428-4766
Mailing Address - Fax:
Practice Address - Street 1:126 S 25TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1364
Practice Address - Country:US
Practice Address - Phone:906-233-9500
Practice Address - Fax:906-233-9925
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053110207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4662541Medicaid
MIP02830001Medicare ID - Type Unspecified
MI4662541Medicaid