Provider Demographics
NPI:1154383693
Name:HULL, JOEL IRVIN (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:IRVIN
Last Name:HULL
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 1:541 OTIS BOWEN DR
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-4158
Mailing Address - Country:US
Mailing Address - Phone:219-934-5300
Mailing Address - Fax:
Practice Address - Street 1:650 DICKINSON RD
Practice Address - Street 2:SUITE A
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-3387
Practice Address - Country:US
Practice Address - Phone:219-926-2133
Practice Address - Fax:219-926-8765
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01020457A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000090557OtherANTHEM
IND69781Medicare UPIN
IN658730CMedicare ID - Type Unspecified