Provider Demographics
NPI:1275584286
Name:HALLAU, DARRELL (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:
Last Name:HALLAU
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 1:11019 STIRRUP LN
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:KY
Mailing Address - Zip Code:41094-9308
Mailing Address - Country:US
Mailing Address - Phone:859-485-9356
Mailing Address - Fax:
Practice Address - Street 1:1011 OLD HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-2519
Practice Address - Country:US
Practice Address - Phone:270-756-7000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15873207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64158736Medicaid
KYC02287Medicare UPIN