Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 5101013323 | MI |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 5101013323 | MI |
NPI | 1497967202 |
---|---|
Provider Name | Timothy Lee Hayes |
First Address | Hillman, MI 49746-0427 |
Second Address | Hillman, MI 49746-7961 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 20/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E51930 | (02) | MI |