Provider Demographics
NPI:1457325946
Name:HAYNE, GREGORY WALTER (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:WALTER
Last Name:HAYNE
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 1:26374 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1263
Mailing Address - Country:US
Mailing Address - Phone:906-225-4606
Mailing Address - Fax:906-225-4537
Practice Address - Street 1:107 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4651
Practice Address - Country:US
Practice Address - Phone:906-225-4606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052446207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP52466OtherSUMMACARE HEALTH PLAN
OH0858451Medicaid
OH101754OtherKAISER
OH000000030816OtherUNICARE- LIFE AND HEALTH
OH110160075OtherRAILROAD
OH000000030816OtherANTHEM BCBS
OH393424OtherWELLCARE OF OH
OH110160075OtherRAILROAD
OHP52466OtherSUMMACARE HEALTH PLAN
OH110160075Medicare PIN