Healthcare Provider Details

I. General information

NPI: 1972682102
Provider Name (Legal Business Name): MARK W HINSHAW MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PARCHMENT DR SE
GRAND RAPIDS MI
49546
US

IV. Provider business mailing address

1000 PARCHMENT DR SE
GRAND RAPIDS MI
49546
US

V. Phone/Fax

Practice location:
  • Phone: 616-957-9197
  • Fax: 616-957-2409
Mailing address:
  • Phone: 616-957-9197
  • Fax: 616-957-2409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301030538
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301030538
License Number StateMI

VIII. Authorized Official

Name: MARK W HINSHAW
Title or Position: PRESIDENT
Credential: MD
Phone: 616-957-9197