Healthcare Provider Details

I. General information

NPI: 1962777110
Provider Name (Legal Business Name): MATTHEW JOSEPH HYNES D.V.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 MACK AVE CLAWS & PAWS CLINIC WSU/DLAR-WCCCD/LVT
DETROIT MI
48201-2427
US

IV. Provider business mailing address

4315 ELEANOR DR
TROY MI
48085-5059
US

V. Phone/Fax

Practice location:
  • Phone: 313-577-1156
  • Fax: 313-577-5890
Mailing address:
  • Phone: 517-862-6854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number5315040836
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code174MM1900X
TaxonomyMedical Research Veterinarian
License Number6901010051
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: