Provider Demographics
NPI:1972511178
Name:HAYWOOD, MITCHELL CARY (DO)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:CARY
Last Name:HAYWOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-2739
Mailing Address - Country:US
Mailing Address - Phone:224-678-9033
Mailing Address - Fax:224-678-9493
Practice Address - Street 1:215 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-2739
Practice Address - Country:US
Practice Address - Phone:224-678-9033
Practice Address - Fax:224-678-9493
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360855302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085530Medicaid
IL378531Medicare ID - Type Unspecified
IL036085530Medicaid