Healthcare Provider Details

I. General information

NPI: 1508046624
Provider Name (Legal Business Name): KEARN D HINCHMAN D O INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53779 GENERATIONS DR STE 1
SOUTH BEND IN
46635-1576
US

IV. Provider business mailing address

53779 GENERATIONS DR STE 1
SOUTH BEND IN
46635-1576
US

V. Phone/Fax

Practice location:
  • Phone: 574-258-6316
  • Fax: 574-258-6307
Mailing address:
  • Phone: 574-258-6316
  • Fax: 574-258-6307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number02001423A
License Number StateIN

VIII. Authorized Official

Name: MARY C HINCHMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 574-258-6316