Provider Demographics
NPI:1861507451
Name:HILGARD, JAMES HANNON (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HANNON
Last Name:HILGARD
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:#2 MEMORIAL DR SUITE 202
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002
Mailing Address - Country:US
Mailing Address - Phone:618-462-5979
Mailing Address - Fax:618-465-8132
Practice Address - Street 1:#2 MEMORIAL DR SUITE 202
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002
Practice Address - Country:US
Practice Address - Phone:618-462-5979
Practice Address - Fax:618-465-8132
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILBCBS 0600527OtherBLUE CROSS BLUE SHIELD
IL739061Medicare ID - Type Unspecified
ILBCBS 0600527OtherBLUE CROSS BLUE SHIELD