Provider Demographics
NPI:1750315602
Name:HAKES, PAUL E (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:HAKES
Suffix:
Gender:M
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:PO BOX 2451
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61702-2451
Mailing Address - Country:US
Mailing Address - Phone:309-268-2172
Mailing Address - Fax:309-268-3649
Practice Address - Street 1:385 S ORANGE ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:IL
Practice Address - Zip Code:61738-1613
Practice Address - Country:US
Practice Address - Phone:309-527-4900
Practice Address - Fax:309-527-3525
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065214207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036065214Medicaid
10220308OtherBLUE CROSS BLUE SHIELD
5720935OtherBLUE CROSS BLUE SHIELD
L39341Medicare ID - Type Unspecified
10220308OtherBLUE CROSS BLUE SHIELD
IL748943Medicare ID - Type UnspecifiedMEDICARE GROUP
IL749842Medicare ID - Type UnspecifiedMEDICARE GROUP
5720935OtherBLUE CROSS BLUE SHIELD
L39338Medicare ID - Type Unspecified