Healthcare Provider Details

I. General information

NPI: 1053499566
Provider Name (Legal Business Name): RICHARD M. HAYES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E LAYTON AVE
SAINT FRANCIS WI
53235-6053
US

IV. Provider business mailing address

100 - 15TH AVE. STE. 180
SOUTH MILWAUKEE WI
53172-1160
US

V. Phone/Fax

Practice location:
  • Phone: 414-744-6589
  • Fax: 414-747-8848
Mailing address:
  • Phone: 414-768-5430
  • Fax: 414-747-8848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number39274-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: