Provider Demographics
NPI:1922006048
Name:HAMMOUD MEDICAL CENTER PC
Entity Type:Organization
Organization Name:HAMMOUD MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-562-9588
Mailing Address - Street 1:PO BOX 77700
Mailing Address - Street 2:DEPT 77261
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-0700
Mailing Address - Country:US
Mailing Address - Phone:313-562-9588
Mailing Address - Fax:313-562-9589
Practice Address - Street 1:22146 FORD RD
Practice Address - Street 2:#3
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2419
Practice Address - Country:US
Practice Address - Phone:313-562-9588
Practice Address - Fax:313-562-9589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1255330767Medicaid
MI080H223200OtherBC GROUP
MI080H223200OtherBCN GROUP
MIDC4758OtherRAILROAD MEDICARE GROUP
MI4650667Medicaid
MI4650667Medicaid
MI080H223200OtherBCN GROUP