Healthcare Provider Details

I. General information

NPI: 1962663302
Provider Name (Legal Business Name): MARTIN CHARLES HINZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 88TH AVE W
DULUTH MN
55808-1505
US

IV. Provider business mailing address

1150 88TH AVE W
DULUTH MN
55808-1505
US

V. Phone/Fax

Practice location:
  • Phone: 218-626-2220
  • Fax: 218-626-1638
Mailing address:
  • Phone: 218-626-2220
  • Fax: 218-626-1638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31670
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: