Provider Demographics
NPI:1770582777
Name:RANDALL-HAYES, LINDIWEE-YAA (MD)
Entity type:Individual
Prefix:DR
First Name:LINDIWEE-YAA
Middle Name:
Last Name:RANDALL-HAYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:SUITE 130 - PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:765-741-1411
Mailing Address - Fax:317-962-4343
Practice Address - Street 1:1606 N 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-2706
Practice Address - Country:US
Practice Address - Phone:812-238-7523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036123561207P00000X
IN01060215A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200513430Medicaid
IN000000358502OtherBLUE CROSS/BLUE SHIELD
IN200513430AMedicaid
IN000000506228OtherANTHEM
INP00382890Medicare PIN
IN809640JJJMedicare UPIN
IN203170NNNMedicare ID - Type Unspecified
IN200513430AMedicaid