Provider Demographics
NPI:1255305223
Name:HYNES, KAREN A (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:HYNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62694-1249
Mailing Address - Country:US
Mailing Address - Phone:217-742-3535
Mailing Address - Fax:217-742-3535
Practice Address - Street 1:39 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62694-1249
Practice Address - Country:US
Practice Address - Phone:217-742-3535
Practice Address - Fax:217-742-3535
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08625736OtherBCBS PROVIDER#
IL624700Medicare UPIN
ILE92376Medicare UPIN