Healthcare Provider Details

I. General information

NPI: 1568443752
Provider Name (Legal Business Name): PETER J HULICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CENTRAL ST SUITE 620
EVANSTON IL
60201-1777
US

IV. Provider business mailing address

1000 CENTRAL ST SUITE 620
EVANSTON IL
60201-1777
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-1029
  • Fax: 847-733-5318
Mailing address:
  • Phone: 847-570-1029
  • Fax: 847-733-5318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number036121377
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: