Provider Demographics
NPI:1992905426
Name:TIMOTHY C HAIN, MD, PC
Entity type:Organization
Organization Name:TIMOTHY C HAIN, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-274-0197
Mailing Address - Street 1:PO BOX 11192
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-0192
Mailing Address - Country:US
Mailing Address - Phone:312-274-0197
Mailing Address - Fax:312-274-0198
Practice Address - Street 1:645 N MICHIGAN AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2826
Practice Address - Country:US
Practice Address - Phone:312-274-0197
Practice Address - Fax:312-274-0198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD72229Medicare UPIN