Provider Demographics
NPI:1831301902
Name:DYE, HILARY K (MD)
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:K
Last Name:DYE
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 1:52500 FIR RD
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8579
Mailing Address - Country:US
Mailing Address - Phone:574-204-7060
Mailing Address - Fax:574-204-7051
Practice Address - Street 1:52500 FIR RD
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8579
Practice Address - Country:US
Practice Address - Phone:574-204-7060
Practice Address - Fax:574-204-7051
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL28384207R00000X
IN01069720B207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09328739Medicaid
AL51593312OtherBCBS - STANTON RD
IN201219130Medicaid
AL51593317OtherBCBS - FILLINGIM ST
IN146470023Medicare PIN
AL510I110267Medicare PIN