Provider Demographics
NPI:1255350674
Name:HULL, KURTIS (MD)
Entity type:Individual
Prefix:
First Name:KURTIS
Middle Name:
Last Name:HULL
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 1:7855 S EMERSON AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8668
Mailing Address - Country:US
Mailing Address - Phone:317-300-0370
Mailing Address - Fax:317-300-0422
Practice Address - Street 1:7855 S EMERSON AVE
Practice Address - Street 2:SUITE H
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8668
Practice Address - Country:US
Practice Address - Phone:317-300-0370
Practice Address - Fax:317-300-0422
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00367017OtherRAILROAD MEDICARE
000000490194OtherBLUE CROSS
000000490194OtherBLUE CROSS
P00367017OtherRAILROAD MEDICARE