Provider Demographics
NPI:1053319277
Name:HULL, SAM F (MD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:F
Last Name:HULL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:951 COUNTRY PL
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2796
Mailing Address - Country:US
Mailing Address - Phone:847-295-5729
Mailing Address - Fax:847-295-5700
Practice Address - Street 1:951 COUNTRY PL
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2796
Practice Address - Country:US
Practice Address - Phone:847-295-5729
Practice Address - Fax:847-295-5700
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110464207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI25139Medicare UPIN