Healthcare Provider Details

I. General information

NPI: 1770512113
Provider Name (Legal Business Name): RICHARD L HINES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 CLEVELAND AVE SUITE 1
STEVENSVILLE MI
49127-9670
US

IV. Provider business mailing address

5515 CLEVELAND AVE SUITE 1
STEVENSVILLE MI
49127-9670
US

V. Phone/Fax

Practice location:
  • Phone: 269-429-6604
  • Fax: 269-429-1715
Mailing address:
  • Phone: 269-429-6604
  • Fax: 269-429-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301051347
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: