Provider Demographics
NPI:1891736419
Name:HAYES, BRADLEY L (MD)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:L
Last Name:HAYES
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1331 S A ST
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-1942
Practice Address - Country:US
Practice Address - Phone:765-552-4600
Practice Address - Fax:765-552-4680
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042666A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000658250OtherBC/BS
IN200033680Medicaid
INP00775288OtherRAILROAD MEDICARE
IN000000626582OtherBC/BS
INP00841041OtherRAILROAD MEDICARE
IN200033680Medicaid
INP00841041OtherRAILROAD MEDICARE
IN261920EMedicare PIN
INP01088261Medicare PIN
IN265520DDMedicare PIN
IN000000626582OtherBC/BS