MEDICARE: MATT HINTZ MD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35084209	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932381597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATT HINTZ MD, LLC

Provider Business Mailing Address
First Line	:	712 BAKER ST
Second Line	:
City	:	MOUNT GILEAD
State	:	OH
Zip	:	43338-1082
Country	:	US
Telephone Number	:	419-947-8001
Fax Number	:	419-946-8214

Provider Business Practice Location Address
First Line	:	712 BAKER ST
Second Line	:
City	:	MOUNT GILEAD
State	:	OH
Zip	:	43338-1082
Country	:	US
Telephone Number	:	419-947-8001
Fax Number	:	419-946-8214

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MATTHEW ALLAN HINTZ
Credential	:	M.D.
Telephone Number	:	419-947-8001

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	10/23/2012

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