Provider Demographics
NPI:1083610612
Name:HALL, ROBERT F JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:F
Last Name:HALL
Suffix:JR
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 1:406 N FRONT ST
Mailing Address - Street 2:STE C
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050
Mailing Address - Country:US
Mailing Address - Phone:815-344-3050
Mailing Address - Fax:844-971-6459
Practice Address - Street 1:406 N FRONT ST
Practice Address - Street 2:STE C
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5593
Practice Address - Country:US
Practice Address - Phone:815-344-3050
Practice Address - Fax:815-344-3822
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036045752174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0418460001OtherADMINISTAR DMEPOS
ILP00160945OtherRR MEDICARE
IL05600198OtherBCBS OF ILLINOIS
IL2299070OtherAETNA HMO
IL036045752Medicaid
IL367120000OtherACS
IL5471649OtherAETNA PPO AND MGD CARE
ILD13550Medicare UPIN