Basic Information
Provider Information
NPI: 1366067142
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAYES
FirstName: JAMES
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DPM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 32645 WOODRIDGE CT
Address2:  
City: NORTH RIDGEVILLE
State: OH
PostalCode: 440392372
CountryCode: US
TelephoneNumber: 4403825103
FaxNumber:  
Practice Location
Address1: 2351 E 22ND ST
Address2:  
City: CLEVELAND
State: OH
PostalCode: 441153111
CountryCode: US
TelephoneNumber: 2168616200
FaxNumber: 2163637490
Other Information
ProviderEnumerationDate: 06/08/2020
LastUpdateDate: 06/08/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/08/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
213E00000X59.000857OHY Podiatric Medicine & Surgery Service ProvidersPodiatrist 

No ID Information.


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