Provider Demographics
NPI:1043235112
Name:HILL, MALCOLM C (MD)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:C
Last Name:HILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W. PARK ST.
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:
Practice Address - Street 1:1818 E WINDSOR RD
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-9566
Practice Address - Country:US
Practice Address - Phone:217-255-9700
Practice Address - Fax:217-255-9650
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064265208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3270022Medicare PIN
IL6447860006Medicare NSC
C48233Medicare UPIN
ILC48233Medicare UPIN