Healthcare Provider Details

I. General information

NPI: 1104934652
Provider Name (Legal Business Name): ENDOCRINE TREATMENT CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WAKE ROBIN RD SUITE 207
LINCOLN RI
02865-4295
US

IV. Provider business mailing address

2 WAKE ROBIN RD SUITE 207
LINCOLN RI
02865-4295
US

V. Phone/Fax

Practice location:
  • Phone: 401-334-2242
  • Fax: 401-334-0376
Mailing address:
  • Phone: 401-334-2242
  • Fax: 401-334-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD07593
License Number StateRI

VIII. Authorized Official

Name: DR. MICHAEL DAVID HEIN
Title or Position: PRESIDENT AND CEO
Credential: M.D.
Phone: 401-334-2242