Healthcare Provider Details

I. General information

NPI: 1811192719
Provider Name (Legal Business Name): MICHELLE RENEE HAYES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 GREENBRIER RD
GREEN BAY WI
54311-6519
US

IV. Provider business mailing address

2456 WATSON CIR
DE PERE WI
54115-1658
US

V. Phone/Fax

Practice location:
  • Phone: 920-288-4560
  • Fax:
Mailing address:
  • Phone: 920-632-4818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number51901
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: