Provider Demographics
NPI:1720275381
Name:ALBERT C. HAYES JR.,MD PC
Entity Type:Organization
Organization Name:ALBERT C. HAYES JR.,MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:313-831-8800
Mailing Address - Street 1:3800 WOODWARD AVE
Mailing Address - Street 2:SUITE 822
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2061
Mailing Address - Country:US
Mailing Address - Phone:313-831-8800
Mailing Address - Fax:313-831-8851
Practice Address - Street 1:3800 WOODWARD AVE
Practice Address - Street 2:SUITE 822
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2061
Practice Address - Country:US
Practice Address - Phone:313-831-8800
Practice Address - Fax:313-831-8851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051664174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3156490Medicaid
MIF14634Medicare UPIN
MI0P19630Medicare PIN