Samuel G Hawk, DO
Individual provider Active NPI General Practice Physician · Ham Lake, MN
NPI 1366763567 · NPPES record last updated Jul 8, 2021
Key facts
- NPI
- 1366763567
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- DOS-1424 (HI)
- Practice address
- 14326 Rochester St NE
Ham Lake, MN 55304-6266 - Phone
- (612) 486-2226
- NPI assigned
- Jun 22, 2010
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DOS-1424 | HI | MD | General Practice Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | DOS-1424 | HI | Yes |
Addresses
Primary practice location
14326 Rochester St NE
Ham Lake, MN 55304-6266
Mailing address
14326 Rochester St NE
Ham Lake, MN 55304-6266
Phone (612) 486-2226
Other providers in Ham Lake, MN
- Carly Furney
- Gatherwell, PLLC
- Goldencare Home Health Services
- Grace-Helen Halvorson
- Ham Lake Dental PA
- Healing Artstherapy Services, LLC
- Robert Charles Hoffmann
- Valorie Dee Hoffmann
- Horizons Community Church
- Scott James Imberg
All providers in Ham Lake, MN · General Practice Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.