MEDICARE: DR. MATTHEW JOSEPH HYNES D.V.M.

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	174M00000X	Veterinarian	5315040836	MI
2	174MM1900X	Medical Research Veterinarian	6901010051	MI

General Provider Information

NPI Number	:	1962777110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW JOSEPH HYNES D.V.M.

Provider Business Mailing Address
First Line	:	4315 ELEANOR DR
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48085-5059
Country	:	US
Telephone Number	:	517-862-6854
Fax Number	:

Provider Business Practice Location Address
First Line	:	259 MACK AVE
Second Line	:	CLAWS & PAWS CLINIC WSU/DLAR-WCCCD/LVT
City	:	DETROIT
State	:	MI
Zip	:	48201-2427
Country	:	US
Telephone Number	:	313-577-1156
Fax Number	:	313-577-5890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2012
Last Update Date	:	03/20/2012

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