MEDICARE: MS. DEBORAH LAURENE HAYS

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	174400000X	Specialist

General Provider Information

NPI Number	:	1366682122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH LAURENE HAYS

Provider Business Mailing Address
First Line	:	5102 N GLENWOOD AVE # 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2819
Country	:	US
Telephone Number	:	773-275-0364
Fax Number	:

Provider Business Practice Location Address
First Line	:	5102 N GLENWOOD AVE # 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2819
Country	:	US
Telephone Number	:	773-275-0364
Fax Number	:

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

Provider Enumeration Date	:	03/05/2009
Last Update Date	:	03/05/2009

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