Provider Demographics
NPI:1578285896
Name:HAYES, ALIA
Entity Type:Individual
Prefix:
First Name:ALIA
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 W BUTTERFIELD RD STE 160
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5099
Mailing Address - Country:US
Mailing Address - Phone:630-782-9600
Mailing Address - Fax:630-782-1643
Practice Address - Street 1:360 W BUTTERFIELD RD STE 160
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5099
Practice Address - Country:US
Practice Address - Phone:630-782-9600
Practice Address - Fax:630-782-1643
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085010037207XX0005X, 363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program