Provider Demographics
NPI:1548243520
Name:FREDRICK C HAYEK MD INC
Entity Type:Organization
Organization Name:FREDRICK C HAYEK MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAYEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-313-5874
Mailing Address - Street 1:3411 CORNWALL DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-1155
Mailing Address - Country:US
Mailing Address - Phone:330-313-5874
Mailing Address - Fax:330-492-7976
Practice Address - Street 1:3411 CORNWALL DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-1155
Practice Address - Country:US
Practice Address - Phone:330-313-5874
Practice Address - Fax:330-492-7976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH48676207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30152288200OtherWORKERS COMP
OH2279681Medicaid
OH2279681Medicaid
OH30152288200OtherWORKERS COMP