Provider Demographics
NPI:1881775880
Name:HAYES, RANDALL DALE (RSA)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:DALE
Last Name:HAYES
Suffix:
Gender:M
Credentials:RSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5102
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-5102
Mailing Address - Country:US
Mailing Address - Phone:630-303-6915
Mailing Address - Fax:630-909-0991
Practice Address - Street 1:1123 CEDAR ST
Practice Address - Street 2:APT. 1-A
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139
Practice Address - Country:US
Practice Address - Phone:630-520-8697
Practice Address - Fax:630-909-0991
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000042246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist