Healthcare Provider Details

I. General information

NPI: 1710209630
Provider Name (Legal Business Name): HALLIE R. HULS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE CHILDREN'S PLAZA C/O CHILDREN'S ANESTHESIA GROUP, INC
DAYTON OH
45404
US

IV. Provider business mailing address

ONE CHILDREN'S PLAZA C/O CHILDREN'S ANESHTESIA GROUP, INC
DAYTON OH
45404
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3350
  • Fax: 937-641-6145
Mailing address:
  • Phone: 937-641-3350
  • Fax: 937-641-6145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number54057-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number35.126757
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: