Provider Demographics
NPI:1356389167
Name:HAYNES, MICHAEL STEPHEN (DPM)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:HAYNES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:200 SILVER ST.
Mailing Address - Street 2:SUITE 215
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001
Mailing Address - Country:US
Mailing Address - Phone:413-786-7522
Mailing Address - Fax:413-789-1198
Practice Address - Street 1:200 SILVER ST.
Practice Address - Street 2:SUITE 215
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001
Practice Address - Country:US
Practice Address - Phone:413-786-7522
Practice Address - Fax:413-789-1198
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1495213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T58689Medicare UPIN
Y70612Medicare PIN