Provider Demographics
NPI:1295725174
Name:HITCHCOCK, JAMES M (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:HITCHCOCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 CROSS ST STE 230
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2941
Mailing Address - Country:US
Mailing Address - Phone:618-607-1260
Mailing Address - Fax:
Practice Address - Street 1:1414 CROSS ST STE 230
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-2941
Practice Address - Country:US
Practice Address - Phone:618-607-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-114626207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL559539145OtherBLUE CROSS BLUE SHIELD
P00912314OtherRR MEDICARE
2696788OtherUHC/COMMERCIAL
678480001OtherDMERC
1046930OtherGHP
7367913OtherAETNA
744967OtherHEALTHLINK
7367913OtherAETNA