Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | TH015883 | MI |
NPI | 1407854003 |
---|---|
Provider Name | Dr. Teri Lynn Hammer |
First Address | Grosse Pointe Woods, MI 48236-1392 |
Second Address | Grosse Pointe Woods, MI 48236-1392 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 17/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1258211835 | BLUE CROSS (01) | MI |
201894790 | TAX ID (01) | MI |
G35906 | (02) |