Basic Information
| Provider Information | |||||||||
| NPI: | 1912925165 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAMMERBERG | ||||||||
| FirstName: | KIM | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P. O. BOX 8500, LOCKBOX 7642 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191787642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132818115 | ||||||||
| FaxNumber: | 8132818656 | ||||||||
| Practice Location | |||||||||
| Address1: | 2211 N. OAK PARK AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607073392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7736225400 | ||||||||
| FaxNumber: | 7733855488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 12/19/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 036-058222 | IL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1633878 | 01 | IL | BCBS ILLINOIS | OTHER | 4316748 | 01 | AETNA | OTHER | 036058222 | 05 | IL | MEDICAID | DA4902 | 01 | IL | RR MEDICARE PTAN NUMBER | OTHER | P00408628 | 01 | IL | RR MEDICARE PROVIDER NUMBER | OTHER |