Basic Information
| Provider Information | |||||||||
| NPI: | 1154356202 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUMMEL | ||||||||
| FirstName: | MILTON | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3929 MERCY DR | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600503151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157590800 | ||||||||
| FaxNumber: | 8157592367 | ||||||||
| Practice Location | |||||||||
| Address1: | 3929 MERCY DR | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600503151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157590800 | ||||||||
| FaxNumber: | 8157592367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 01/09/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | IL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0360810332 | 05 | IL | MEDICAID |