Provider Demographics
NPI:1831112036
Name:HILLMAN, STEPHEN ALAN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ALAN
Last Name:HILLMAN
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:PO BOX 60790
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91116-6790
Mailing Address - Country:US
Mailing Address - Phone:818-845-6206
Mailing Address - Fax:626-396-0851
Practice Address - Street 1:501 S BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4809
Practice Address - Country:US
Practice Address - Phone:818-843-5111
Practice Address - Fax:818-847-3935
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70482207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G704820OtherBLUE SHIELD
CA00G704820Medicaid
CA00G704820OtherBLUE SHIELD
CAG70482AMedicare PIN
CAG70482BMedicare PIN
CADF193XMedicare PIN
A62106Medicare UPIN
CAG70482CMedicare PIN
CA00G704820Medicaid
CADF193YMedicare PIN
CAG70482Medicare PIN