Basic Information
| Provider Information | |||||||||
| NPI: | 1487617296 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAYES | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | NELSON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 549 | ||||||||
| Address2: | |||||||||
| City: | IRON MOUNTAIN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498010549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9067741313 | ||||||||
| FaxNumber: | 9067765639 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NORWAY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498701238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9065639255 | ||||||||
| FaxNumber: | 9065639706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 07/10/2012 | ||||||||
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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 | 035335 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 41583-020 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QG0300X | 035335 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 207QG0300X | 41583-020 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0802203531 | 01 | MI | BCBS MI | OTHER | 30119000 | 05 | WI | MEDICAID | 20897-1 | 01 | MI | FAA | OTHER | 1099106 | 05 | MI | MEDICAID | 975871007383 | 01 | MI | PREFERRED ONE | OTHER | P00626144 | 01 | MI | RR MEDICARE | OTHER |