Individual
DR. KIM W HAMMERBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2211 N. OAK PARK AVE, CHICAGO, IL 60707-3392
(773) 622-5400
(773) 385-5488
Mailing address
P. O. BOX 8500, LOCKBOX 7642, PHILADELPHIA, PA 19178-7642
(813) 281-8115
(813) 281-8656
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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