Healthcare Provider Details

I. General information

NPI: 1295725174
Provider Name (Legal Business Name): JAMES M HITCHCOCK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 CROSS ST STE 230
SHILOH IL
62269-2941
US

IV. Provider business mailing address

1414 CROSS ST STE 230
SHILOH IL
62269-2941
US

V. Phone/Fax

Practice location:
  • Phone: 618-607-1260
  • Fax:
Mailing address:
  • Phone: 618-607-1260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-114626
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: