Provider Demographics
NPI:1780684936
Name:PEARLMAN, M HAL (MD)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:HAL
Last Name:PEARLMAN
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 1:305 W JACKSON ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1474
Mailing Address - Country:US
Mailing Address - Phone:618-457-0451
Mailing Address - Fax:618-529-3826
Practice Address - Street 1:305 W JACKSON ST
Practice Address - Street 2:SUITE 302
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1474
Practice Address - Country:US
Practice Address - Phone:618-457-0451
Practice Address - Fax:618-529-3826
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2014-02-10
Deactivation Date:2009-01-20
Deactivation Code:
Reactivation Date:2014-02-10
Provider Licenses
StateLicense IDTaxonomies
IL036064119207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064119Medicaid
IL732760Medicare ID - Type Unspecified
IL036064119Medicaid