# DR. KIM W HAMMERBERG

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1912925165
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 036-058222 | IL | Yes |

## Other

- **Enumeration date:** 07/17/2006
- **Last updated:** 12/19/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036058222 | — | IL |
| 01 | — | 1633878 | BCBS ILLINOIS | IL |
| 01 | — | 4316748 | AETNA | — |
| 01 | — | DA4902 | RR MEDICARE PTAN NUMBER | IL |
| 01 | — | P00408628 | RR MEDICARE PROVIDER NUMBER | IL |