Provider Demographics
NPI:1609855634
Name:HAMILTON, TREVOR J (MD)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:J
Last Name:HAMILTON
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 1:75 REMITTANCE DR
Mailing Address - Street 2:SUITE 1951
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-1001
Mailing Address - Country:US
Mailing Address - Phone:847-535-7917
Mailing Address - Fax:847-535-7801
Practice Address - Street 1:660 N WESTMORELAND RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1659
Practice Address - Country:US
Practice Address - Phone:847-535-7917
Practice Address - Fax:847-535-7801
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-102287207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102287Medicaid
ILL90611Medicare ID - Type Unspecified
ILH55937Medicare UPIN