MEDICARE: DR. RANDALL LEE HILE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	01030234A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110007891	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000085930	OTHER	IN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1861425068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL LEE HILE M.D.

Provider Business Mailing Address
First Line	:	6105 W 177TH AVE
Second Line	:
City	:	LOWELL
State	:	IN
Zip	:	46356-1971
Country	:	US
Telephone Number	:	219-696-0779
Fax Number	:	219-696-4629

Provider Business Practice Location Address
First Line	:	1020 E COMMERCIAL AVE
Second Line	:
City	:	LOWELL
State	:	IN
Zip	:	46356-2310
Country	:	US
Telephone Number	:	219-696-3052
Fax Number	:	219-696-4629

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	05/01/2013

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