Provider Demographics
NPI:1164483434
Name:HAYES, JEFFREY R (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:HAYES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35050 23 MILE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-3606
Mailing Address - Country:US
Mailing Address - Phone:586-725-0477
Mailing Address - Fax:586-725-8835
Practice Address - Street 1:35050 23 MILE RD
Practice Address - Street 2:SUITE B
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-3606
Practice Address - Country:US
Practice Address - Phone:586-725-0477
Practice Address - Fax:586-725-8835
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E031610OtherBCBS GROUP NUMBER
MI4373271Medicaid
MI700E031610OtherBCBS GROUP NUMBER
MIE49721Medicare UPIN
MIMI3971Medicare PIN