Provider Demographics
NPI:1477556892
Name:HACKER, DAWN L (DO)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:L
Last Name:HACKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24826 S WILLOW BROOK TRL
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-3715
Mailing Address - Country:US
Mailing Address - Phone:219-689-1073
Mailing Address - Fax:
Practice Address - Street 1:9301 MADISON ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7745
Practice Address - Country:US
Practice Address - Phone:219-662-5000
Practice Address - Fax:219-662-5181
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200379960AMedicaid
IN200379960AMedicaid