Provider Demographics
NPI:1063451185
Name:HITTLEMAN, GARY A (BC-HIS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:HITTLEMAN
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 945
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-0945
Mailing Address - Country:US
Mailing Address - Phone:847-975-8149
Mailing Address - Fax:847-520-3373
Practice Address - Street 1:249 N WOLF RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-2921
Practice Address - Country:US
Practice Address - Phone:847-975-8149
Practice Address - Fax:847-520-3373
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1732237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist