1548248453 NPI number — DR. SULTAN A HAYAT MD

Table of content: DR. SULTAN A HAYAT MD (NPI 1548248453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548248453 NPI number — DR. SULTAN A HAYAT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAYAT
Provider First Name:
SULTAN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548248453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4600 MEMORIAL DR STE W1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62226-5359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-233-3066
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4600 MEMORIAL DR STE W1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62226-5359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-233-3066
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  036065513 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 371386990 . This is a "GREAT WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2276V43658 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4000441 . This is a "AETNA PPO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 06065636 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2507046 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 036065513 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1548248456 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8232003 . This is a "BCBS IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 371386990 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 45523 . This is a "UHC GENCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 98322 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100639 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2600834 . This is a "AETNA HMO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0973882-003 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2808 . This is a "BCBS MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: C42399 . This is a "MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: L025925 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".




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