Provider Demographics
NPI:1700966785
Name:HILLARD, JAMES RANDOLPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RANDOLPH
Last Name:HILLARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 FOUST HALL
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48859-0001
Mailing Address - Country:US
Mailing Address - Phone:989-774-6599
Mailing Address - Fax:989-774-4335
Practice Address - Street 1:202 FOUST HALL
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48859-1037
Practice Address - Country:US
Practice Address - Phone:989-774-6599
Practice Address - Fax:989-774-4335
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH504392084P0800X
MI43010412402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1700966785Medicaid
MI1700966785Medicaid
MIC36166041Medicare PIN