Provider Demographics
NPI:1326664376
Name:HYALND, PAUL RICHARD (MS)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:RICHARD
Last Name:HYALND
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 FOREST AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4165
Mailing Address - Country:US
Mailing Address - Phone:866-577-2263
Mailing Address - Fax:888-647-7279
Practice Address - Street 1:17 FOREST AVE STE 12
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4165
Practice Address - Country:US
Practice Address - Phone:866-577-2263
Practice Address - Fax:888-647-7279
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17155-62171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor