MEDICARE: SAM F HULL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036110464	IL

General Provider Information

NPI Number	:	1053319277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAM F HULL MD

Provider Business Mailing Address
First Line	:	951 COUNTRY PL
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-2796
Country	:	US
Telephone Number	:	847-295-5729
Fax Number	:	847-295-5700

Provider Business Practice Location Address
First Line	:	951 COUNTRY PL
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-2796
Country	:	US
Telephone Number	:	847-295-5729
Fax Number	:	847-295-5700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	03/05/2015

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