Provider Demographics
NPI:1750385647
Name:HAM, MICHAEL LEE (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:HAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2820 N GLASSFORD HILL RD
Mailing Address - Street 2:STE 101
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2256
Mailing Address - Country:US
Mailing Address - Phone:928-775-5606
Mailing Address - Fax:928-772-4999
Practice Address - Street 1:2820 N GLASSFORD HILL RD
Practice Address - Street 2:STE 101
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2256
Practice Address - Country:US
Practice Address - Phone:928-775-5606
Practice Address - Fax:928-772-4999
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2012-07-16
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Provider Licenses
StateLicense IDTaxonomies
AZ26357207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXPY190835Medicaid
AZZ102609Medicare PIN
AZG20352Medicare UPIN