=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336457753
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRUCE W. HALLMANN, M.D.S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2010
-----------------------------------------------------
Last Update Date | 09/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5201 WILLOW SPRINGS RD SUITE 220
-----------------------------------------------------
City | LA GRANGE HIGHLANDS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60525-6537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-588-0334
-----------------------------------------------------
Fax | 708-588-0337
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5201 WILLOW SPRINGS RD SUITE 220
-----------------------------------------------------
City | LA GRANGE HIGHLANDS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60525-6537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-588-0334
-----------------------------------------------------
Fax | 708-588-0337
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BRUCE W. HALLMANN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 708-588-0334
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------