Provider Demographics
NPI:1265545677
Name:HACKERT, PAMELA B (MD, JD, MPH)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:B
Last Name:HACKERT
Suffix:
Gender:F
Credentials:MD, JD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:26491 CAROL AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-1781
Mailing Address - Country:US
Mailing Address - Phone:248-752-5257
Mailing Address - Fax:248-452-9754
Practice Address - Street 1:100 E MICHIGAN AVE STE 101
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1406
Practice Address - Country:US
Practice Address - Phone:517-205-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR00603212083P0500X
MI43010614282083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine