Healthcare Provider Details

I. General information

NPI: 1083610612
Provider Name (Legal Business Name): ROBERT F HALL JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 N FRONT ST STE C
MCHENRY IL
60050-5593
US

IV. Provider business mailing address

406 N FRONT ST STE C
MCHENRY IL
60050
US

V. Phone/Fax

Practice location:
  • Phone: 815-344-3050
  • Fax: 815-344-3822
Mailing address:
  • Phone: 815-344-3050
  • Fax: 844-971-6459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036045752
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: