Individual
DR. KIM W HAMMERBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036-058222
IL
Other
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
Enumeration date
07/17/2006
Last updated
12/19/2012
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