MEDICARE: DR. MICHAEL C HYRE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036064919	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4632039	OTHER	IL	BC GROUP #

General Provider Information

NPI Number	:	1083713978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL C HYRE MD

Provider Business Mailing Address
First Line	:	PO BOX 781
Second Line	:
City	:	KANKAKEE
State	:	IL
Zip	:	60901-0781
Country	:	US
Telephone Number	:	815-935-7256
Fax Number	:	815-935-7340

Provider Business Practice Location Address
First Line	:	611 S DIVISION ST
Second Line	:
City	:	PEOTONE
State	:	IL
Zip	:	60468-9590
Country	:	US
Telephone Number	:	708-258-9058
Fax Number	:	708-258-0421

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/09/2007

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