Basic Information
Provider Information
NPI: 1114344397
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAYES
FirstName: KYLE
MiddleName: MATTHEW
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 6005 DEPT 196
Address2:  
City: INDIANAPOLIS
State: IN
PostalCode: 462066005
CountryCode: US
TelephoneNumber: 1736149817
FaxNumber: 3176149655
Practice Location
Address1: 2001 W 86TH ST
Address2: DEPARTMENT OF MEDICAL EDUCATION
City: INDIANAPOLIS
State: IN
PostalCode: 462601902
CountryCode: US
TelephoneNumber: 3173382281
FaxNumber: 3173382851
Other Information
ProviderEnumerationDate: 03/25/2014
LastUpdateDate: 03/27/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X01078100AINY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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