Provider Demographics
NPI:1992781702
Name:HALL, CALVIN JR (MD)
Entity type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:
Last Name:HALL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S MICHIGAN AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2857
Mailing Address - Country:US
Mailing Address - Phone:312-326-2600
Mailing Address - Fax:312-326-2636
Practice Address - Street 1:2600 S MICHIGAN AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2857
Practice Address - Country:US
Practice Address - Phone:312-326-2600
Practice Address - Fax:312-326-2636
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053292207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1992781702OtherNPI - INDIVIDUAL
IL001617095OtherBSBS - IL - INDIVIDUAL
IL01621679OtherBCBS - GROUP - ILLINOIS
IL036053292Medicaid
IL100008176OtherRAILROAD - IL
IL705190OtherMEDICARE PROVIDER NUMBER
IL001617095OtherBSBS - IL - INDIVIDUAL
IL1992781702OtherNPI - INDIVIDUAL