Healthcare Provider Details

I. General information

NPI: 1407085129
Provider Name (Legal Business Name): CARL HINSHAW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WEALTHY ST SE STE 300
GRAND RAPIDS MI
49506-2969
US

IV. Provider business mailing address

100 MICHIGAN ST NE MC845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-774-8345
  • Fax: 616-774-8350
Mailing address:
  • Phone: 616-486-6790
  • Fax: 616-486-6702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4301094773
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: