1407831795 NPI number — K. HAMAMDJIAN MD PC

Table of content: (NPI 1407831795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407831795 NPI number — K. HAMAMDJIAN MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
K. HAMAMDJIAN MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407831795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 MANORWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMFIELD HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48304-2133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-642-1389
Provider Business Mailing Address Fax Number:
248-353-0883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27177 LAHSER RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48034-4714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-353-6580
Provider Business Practice Location Address Fax Number:
248-353-0883
Provider Enumeration Date:
12/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HAMAMDJIAN
Authorized Official First Name:
KHATCHADOUR
Authorized Official Middle Name:
WAHAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-642-1389

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  4301037656 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4557191 . This is a "AETNA INSURANCE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 280F339180 . This is a "BLUE CROSS BLUE SHIELD MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4137828 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 128807 . This is a "CARE CHOICE HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2440249001 . This is a "CIGNA INS." identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 354121 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 128807 . This is a "PREFERRED CHOICE PPO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 280000118 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: A78356 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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