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1851384754

NPI Code Detail

MEDICARE: KALISHA ASHARA HILL MD

MEDICARE: KALISHA ASHARA HILL 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	01057306A	IN
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5496754	OTHER	IN	CCN
2	01630255	OTHER	IL	BC/BS
3	297680	OTHER	IN	BC/BS

General Provider Information

NPI Number	:	1851384754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALISHA ASHARA HILL MD

Provider Business Mailing Address
First Line	:	113 E 4TH ST
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-3301
Country	:	US
Telephone Number	:	219-879-2208
Fax Number	:	219-873-3131

Provider Business Practice Location Address
First Line	:	20201 CRAWFORD AVE
Second Line	:	ST JAMES HOSPITAL OLYMPIA FIELDS CAMPUS
City	:	OLYMPIA FIELDS
State	:	IL
Zip	:	60461-1010
Country	:	US
Telephone Number	:	708-747-4000
Fax Number	:	708-503-3242

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	04/16/2008

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Directions to “ KALISHA ASHARA HILL MD” Practice Location

Language	Start Address	Practice Location

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