Provider Demographics
NPI:1083776678
Name:HAYES, ERNEST ANDERSON (MD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:ANDERSON
Last Name:HAYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ERNEST
Other - Middle Name:ANDERSON
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8012 S CRANDON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-1124
Mailing Address - Country:US
Mailing Address - Phone:773-356-5415
Mailing Address - Fax:773-768-6141
Practice Address - Street 1:3330 W 177TH ST STE 3G
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2199
Practice Address - Country:US
Practice Address - Phone:708-333-3030
Practice Address - Fax:708-914-6020
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036043976207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10639301OtherCAQH
IL036043976Medicaid
IL036043976Medicaid