Basic Information
Provider Information | |||||||||
NPI: | 1205849668 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HAMMEL | ||||||||
FirstName: | IRIANA | ||||||||
MiddleName: | S | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HAMMEL | ||||||||
OtherFirstName: | IRIANA | ||||||||
OtherMiddleName: | S | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1000 HOUGHTON AVE | ||||||||
Address2: |   | ||||||||
City: | SAGINAW | ||||||||
State: | MI | ||||||||
PostalCode: | 486025303 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9895836812 | ||||||||
FaxNumber: | 9895836915 | ||||||||
Practice Location | |||||||||
Address1: | 1201 NW 16TH ST | ||||||||
Address2: |   | ||||||||
City: | MIAMI | ||||||||
State: | FL | ||||||||
PostalCode: | 331251624 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3055757000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/15/2006 | ||||||||
LastUpdateDate: | 07/15/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/15/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 4301081111 | MI | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207RG0300X | ME109215 | FL | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
ID | Type | State | Issuer | Description | IH081111 | 01 | MI | LICENSE NUMBER | OTHER | 381870664 | 01 | MI | TAX ID | OTHER | 700G360210 | 01 |   | BCBSM GROUP PIN | OTHER | 01005357 | 01 |   | HEALTHPLUS OF MICHIGAN | OTHER | P00381891 | 01 |   | RAILROAD MEDICARE | OTHER | 1205849668 | 05 | MI |   | MEDICAID | 144006 | 01 |   | GREAT LAKES HEALTH PLAN | OTHER |