Provider Demographics
NPI:1972693018
Name:HALL, JAMES DAVID (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:HALL
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 1:3301 CRANBERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-5216
Mailing Address - Country:US
Mailing Address - Phone:715-393-3900
Mailing Address - Fax:
Practice Address - Street 1:3301 CRANBERRY BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-5216
Practice Address - Country:US
Practice Address - Phone:715-393-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG084053208G00000X
IL036128462208G00000X
WI56151-20208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G840530Medicaid
IL036128462Medicaid
WI1972693018Medicaid
CA00G840530Medicaid
WIWI2608001Medicare PIN
IL036128462Medicaid
IL535550008Medicare PIN
IL969780007Medicare PIN