Healthcare Provider Details

I. General information

NPI: 1063978476
Provider Name (Legal Business Name): ANDREW STEVEN HALLUM FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 N RANDALL RD STE 200
ELGIN IL
60123-9402
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-214-5740
  • Fax: 847-214-5757
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.018675
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: