Healthcare Provider Details

I. General information

NPI: 1154383693
Provider Name (Legal Business Name): JOEL IRVIN HULL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 DICKINSON RD SUITE A
CHESTERTON IN
46304-3387
US

IV. Provider business mailing address

541 OTIS BOWEN DR
MUNSTER IN
46321-4158
US

V. Phone/Fax

Practice location:
  • Phone: 219-926-2133
  • Fax: 219-926-8765
Mailing address:
  • Phone: 219-934-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01020457A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: