Provider Demographics
NPI:1689770992
Name:HALLMANN, BRUCE WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:WILLIAM
Last Name:HALLMANN
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 1:5201 S WILLOW SPRINGS RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525
Mailing Address - Country:US
Mailing Address - Phone:708-588-0334
Mailing Address - Fax:708-588-0337
Practice Address - Street 1:5201 S WILLOW SPRINGS RD
Practice Address - Street 2:SUITE 220
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525
Practice Address - Country:US
Practice Address - Phone:708-588-0334
Practice Address - Fax:708-588-0337
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055517207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5151090001OtherDMERC
IL036055517Medicaid
IL200005698OtherRAILROAD MEDICARE
IL036055517Medicaid
IL683891Medicare ID - Type Unspecified