Basic Information
Provider Information
NPI: 1023699394
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAYS
FirstName: SARAH
MiddleName: BRADLEY
NamePrefix:  
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Credential:  
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Mailing Information
Address1: 180 HARVESTER DR STE 110
Address2:  
City: BURR RIDGE
State: IL
PostalCode: 605276686
CountryCode: US
TelephoneNumber: 7737021150
FaxNumber:  
Practice Location
Address1: 5841 S MARYLAND AVE # 6040
Address2:  
City: CHICAGO
State: IL
PostalCode: 606371443
CountryCode: US
TelephoneNumber: 7737026337
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/19/2021
LastUpdateDate: 04/19/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialCredential:  
NPICertificationDate: 04/19/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X125.077399ILY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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