Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | POD001013 | AZ |
N | 213ES0103X | Foot & Ankle Surgery | SC006827 | PA |
NPI | 1053832832 |
---|---|
Provider Name | Dr. Michael Hansol Ham JR. |
First Address | Chandler, AZ 85286-2019 |
Second Address | Chandler, AZ 85286-2019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2017 |
Last Update Date | 24/08/2021 |