Provider Demographics
NPI:1104924638
Name:HAYES, RICHARD MARTIN (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MARTIN
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 1:4801 W PETERSON AVE
Mailing Address - Street 2:#600
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5713
Mailing Address - Country:US
Mailing Address - Phone:773-777-0078
Mailing Address - Fax:773-777-0474
Practice Address - Street 1:4801 W PETERSON AVE
Practice Address - Street 2:#600
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5713
Practice Address - Country:US
Practice Address - Phone:773-777-0078
Practice Address - Fax:773-777-0474
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036077240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31603102OtherBC/BS
IL904410Medicare ID - Type Unspecified
IL31603102OtherBC/BS