Provider Demographics
NPI:1205898194
Name:HALL, MARTIN R (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:R
Last Name:HALL
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 1:3330 WEST 177TH ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429
Mailing Address - Country:US
Mailing Address - Phone:708-799-1144
Mailing Address - Fax:708-799-4899
Practice Address - Street 1:3330 WEST 177TH ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429
Practice Address - Country:US
Practice Address - Phone:708-799-1144
Practice Address - Fax:708-799-4899
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036580A207X00000X
IL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDE2045OtherRR MEDICARE
ILDD9203OtherRR MEDICARE
IL31603346OtherBCBS
IN000000095624OtherANTHEM BCBS
36379809016898OtherADVOCATE
4339671OtherAETNA
IN1023490002Medicare NSC
INDE2045OtherRR MEDICARE
4339671OtherAETNA
IL211781Medicare PIN
ILK18335Medicare PIN
IL557620Medicare PIN
36379809016898OtherADVOCATE
ILDD9203OtherRR MEDICARE
ILK47609Medicare PIN