Basic Information
Provider Information
NPI: 1538689872
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAMILTON
FirstName: COREY
MiddleName: ALEXANDER
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9650 GROSS POINT RD STE 2900
Address2:  
City: SKOKIE
State: IL
PostalCode: 600765006
CountryCode: US
TelephoneNumber: 8478667846
FaxNumber: 2242512905
Practice Location
Address1: 9650 GROSS POINT RD STE 2900
Address2:  
City: SKOKIE
State: IL
PostalCode: 600765006
CountryCode: US
TelephoneNumber: 8478667846
FaxNumber: 2242512905
Other Information
ProviderEnumerationDate: 06/27/2017
LastUpdateDate: 07/28/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/28/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207XS0114X036161406ILY Allopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery

No ID Information.


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