Provider Demographics
NPI:1316044415
Name:HYMAN, BRUCE DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DAVID
Last Name:HYMAN
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 1:550 N LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1827
Mailing Address - Country:US
Mailing Address - Phone:847-566-5200
Mailing Address - Fax:847-566-5522
Practice Address - Street 1:550 N LAKE ST
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1827
Practice Address - Country:US
Practice Address - Phone:847-566-5200
Practice Address - Fax:847-566-5522
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36087522207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087522Medicaid
277530Medicare ID - Type Unspecified
IL036087522Medicaid