Provider Demographics
NPI:1154348951
Name:HINES-MAYS, CRYSTAL D (MD)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:D
Last Name:HINES-MAYS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15516 SCOTSGLEN RD
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2328
Mailing Address - Country:US
Mailing Address - Phone:773-512-6968
Mailing Address - Fax:
Practice Address - Street 1:12701 W 143RD ST
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-7715
Practice Address - Country:US
Practice Address - Phone:815-300-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-107239207Q00000X
IL36107239207RG0300X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01067879AOtherSTATE LICENSE
ILF400093321OtherMEDICARE PTAN
IN01067879AOtherSTATE LICENSE
ILH75168Medicare UPIN