Provider Demographics
NPI:1891723185
Name:HACKEL, GREG (DO)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:HACKEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2450 MIDVALE ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1521
Mailing Address - Country:US
Mailing Address - Phone:313-399-9803
Mailing Address - Fax:313-972-9038
Practice Address - Street 1:9100 BROMBACH ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3473
Practice Address - Country:US
Practice Address - Phone:313-972-9001
Practice Address - Fax:313-972-9038
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101011844207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4834332Medicaid
MI700F374320OtherBCBS OF MI
MICA1704-P00278505OtherRR MEDICARE
MIG29827Medicare UPIN
MI4834332Medicaid