Provider Demographics
NPI:1922097724
Name:HILLE, MARC R (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:R
Last Name:HILLE
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:STE. 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-713-7060
Mailing Address - Fax:405-713-7064
Practice Address - Street 1:3330 NW 56TH ST
Practice Address - Street 2:STE. 305
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4479
Practice Address - Country:US
Practice Address - Phone:405-713-7060
Practice Address - Fax:405-713-7064
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK132772084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD34796Medicare UPIN