Basic Information
| Provider Information | |||||||||
| NPI: | 1083713978 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HYRE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 781 | ||||||||
| Address2: | |||||||||
| City: | KANKAKEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609010781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159357256 | ||||||||
| FaxNumber: | 8159357340 | ||||||||
| Practice Location | |||||||||
| Address1: | 611 S DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | PEOTONE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604689590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082589058 | ||||||||
| FaxNumber: | 7082580421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 207R00000X | 036064919 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 36064919 | 05 | IL | MEDICAID | 4632039 | 01 | IL | BC GROUP # | OTHER |