Individual
DR. FREDERICK P. HAYNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-1228
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-8107
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036-042860
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020016079
RAILROAD MEDICARE
—
05
—
036042860 1
—
IL
01
—
279500
MEDICARE GROUP
—
Enumeration date
08/01/2006
Last updated
10/15/2014
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