Provider Demographics
NPI:1447309745
Name:HULL MEDICAL GROUP, P.C.
Entity type:Organization
Organization Name:HULL MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KURTIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HULL
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:317-300-0370
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF4543OtherRAILROAD MEDICARE
IN247460Medicare PIN
DF4543OtherRAILROAD MEDICARE