Healthcare Provider Details

I. General information

NPI: 1124024492
Provider Name (Legal Business Name): MARK D HILLARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 W SYLVANIA AVE STE 100
TOLEDO OH
43623-4465
US

IV. Provider business mailing address

2200 JEFFERSON AVE 4TH FLOOR
TOLEDO OH
43604-7101
US

V. Phone/Fax

Practice location:
  • Phone: 419-472-1124
  • Fax: 419-486-8857
Mailing address:
  • Phone: 419-251-1963
  • Fax: 419-486-8857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35049105H
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: