Basic Information
| Provider Information | |||||||||
| NPI: | 1548300395 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HILGERS | ||||||||
| FirstName: | MARC | ||||||||
| MiddleName: | PETER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD, PHD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2357 SEQUOIA DR | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605066222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308596800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1221 N HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605061404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308598700 | ||||||||
| FaxNumber: | 6302648423 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 11/23/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | ME 99969 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS0010X | 01061202A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 208D00000X | ME99969 | FL | N | Allopathic & Osteopathic Physicians | General Practice | 207QS0010X | 036137322 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 279540000 | 05 | FL | MEDICAID | 7256795 | 01 | FL | AETNA | OTHER | 5153845 | 01 | FL | CIGNA | OTHER | 05368 | 01 | FL | BC/BS | OTHER | P00459922 | 01 | FL | MEDICARE RAILROAD | OTHER | 036137322 | 05 | IL | MEDICAID | 311399 | 01 | FL | AVMED | OTHER |