Healthcare Provider Details

I. General information

NPI: 1053319277
Provider Name (Legal Business Name): SAM F HULL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 COUNTRY PL
LAKE FOREST IL
60045-2796
US

IV. Provider business mailing address

951 COUNTRY PL
LAKE FOREST IL
60045-2796
US

V. Phone/Fax

Practice location:
  • Phone: 847-295-5729
  • Fax: 847-295-5700
Mailing address:
  • Phone: 847-295-5729
  • Fax: 847-295-5700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036110464
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: