Healthcare Provider Details

I. General information

NPI: 1164887006
Provider Name (Legal Business Name): HAYLEY THEA SPARKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2015
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 W NORTH AVE
CHICAGO IL
60647-5247
US

IV. Provider business mailing address

1810 N FREMONT ST APT 12
CHICAGO IL
60614-5073
US

V. Phone/Fax

Practice location:
  • Phone: 312-666-3494
  • Fax:
Mailing address:
  • Phone: 240-997-5364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.174050
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: