1417247768 NPI number — ADAM GORDON HAMILTON MA, LLPC

Table of content: ADAM GORDON HAMILTON MA, LLPC (NPI 1417247768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417247768 NPI number — ADAM GORDON HAMILTON MA, LLPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMILTON
Provider First Name:
ADAM
Provider Middle Name:
GORDON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LLPC
Provider Gender Code:
M

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:
1417247768
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3345 ASPEN DR APT 4203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORION
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48359-2323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-568-5180
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50505 SCHOENHERR RD
Provider Second Line Business Practice Location Address:
STE. 270
Provider Business Practice Location Address City Name:
SHELBY TWP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48315-3140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-731-4100
Provider Business Practice Location Address Fax Number:
586-731-4063
Provider Enumeration Date:
04/07/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  6401011306 , 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)