Provider Demographics
NPI:1740369966
Name:HAMM, JOHN R (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:HAMM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10349 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-3710
Mailing Address - Country:US
Mailing Address - Phone:773-445-7400
Mailing Address - Fax:773-445-9821
Practice Address - Street 1:10349 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-3710
Practice Address - Country:US
Practice Address - Phone:773-445-7400
Practice Address - Fax:773-445-9821
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003453213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL480010130OtherRAILROAD MEDICARE
IL731951Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER