Healthcare Provider Details

I. General information

NPI: 1831143262
Provider Name (Legal Business Name): WENDELL J HYINK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 N SAINT JOSEPH AVE ANESTHESIA DEPARTMENT
NILES MI
49120-2207
US

IV. Provider business mailing address

PO BOX 458
NILES MI
49120-0458
US

V. Phone/Fax

Practice location:
  • Phone: 269-684-1432
  • Fax: 269-684-0259
Mailing address:
  • Phone: 269-684-0259
  • Fax: 269-684-0189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301037510
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: