Provider Demographics
NPI:1528197456
Name:HULL, ANNETTE R (MD)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:R
Last Name:HULL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6308 8TH AVE
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5031
Mailing Address - Country:US
Mailing Address - Phone:262-653-5300
Mailing Address - Fax:262-653-5412
Practice Address - Street 1:6308 8TH AVE
Practice Address - Street 2:SUITE 2000
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5031
Practice Address - Country:US
Practice Address - Phone:262-653-5300
Practice Address - Fax:262-653-5412
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2008-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI37496207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32202100Medicaid
F99867Medicare UPIN