Healthcare Provider Details

I. General information

NPI: 1922639749
Provider Name (Legal Business Name): MADELINE ANNE HULTZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELINE ANNE HAMILTON

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MAINE ST
QUINCY IL
62301-4096
US

IV. Provider business mailing address

1025 MAINE ST
QUINCY IL
62301-4096
US

V. Phone/Fax

Practice location:
  • Phone: 217-222-6550
  • Fax:
Mailing address:
  • Phone: 217-222-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036179901
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number94-11571
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2023019821
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: