Basic Information
| Provider Information | |||||||||
| NPI: | 1164483434 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAYES | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35050 23 MILE RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | NEW BALTIMORE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480473606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867250477 | ||||||||
| FaxNumber: | 5867258835 | ||||||||
| Practice Location | |||||||||
| Address1: | 35050 23 MILE RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | NEW BALTIMORE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480473606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867250477 | ||||||||
| FaxNumber: | 5867258835 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 09/26/2011 | ||||||||
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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 | 207Q00000X | 5101009868 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 700E031610 | 01 | MI | BCBS GROUP NUMBER | OTHER | 4373271 | 05 | MI | MEDICAID |