Basic Information
| Provider Information | |||||||||
| NPI: | 1043265804 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALLOCK | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 E WISCONSIN AVE | ||||||||
| Address2: | SUITE 2000 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532024815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142906720 | ||||||||
| FaxNumber: | 4142906755 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 E WISCONSIN AVE | ||||||||
| Address2: | SUITE 2000 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532024815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142906720 | ||||||||
| FaxNumber: | 4142906755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 05/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 26624 | WV | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 44713-020 | WI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 035105392 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | D75037 | MD | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 930118424 | 01 | IL | MEDICARE RAILROAD | OTHER | P00012889 | 01 | WI | MEDICARE RAILROAD | OTHER | 036105392 | 05 | IL | MEDICAID | 34602500 | 05 | WI | MEDICAID | P00043244 | 01 | IL | MEDICARE RAILROAD | OTHER |