MEDICARE: DR. WENDELL J HYINK M.D.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	4301037510	MI

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	0M30900	OTHER	MI	MEDICARE GROUP PTAN
5	M30900008	OTHER	MI	MEDICARE INDIVIDUAL PTAN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1356370241	OTHER	MI	GROUP NPI
2	050A111210	OTHER	MI	GROUP BCBS PIN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	WH037510	OTHER	MI	INDIVIDUAL BCBS LICENSE NUMBER

NPI Number	:	1831143262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WENDELL J HYINK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 458
Second Line	:
City	:	NILES
State	:	MI
Zip	:	49120-0458
Country	:	US
Telephone Number	:	269-684-0259
Fax Number	:	269-684-0189

Provider Business Practice Location Address
First Line	:	31 N SAINT JOSEPH AVE
Second Line	:	ANESTHESIA DEPARTMENT
City	:	NILES
State	:	MI
Zip	:	49120-2207
Country	:	US
Telephone Number	:	269-684-1432
Fax Number	:	269-684-0259

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	08/12/2008

61 N SAINT JOSEPH AVE
NILES, MI
49120-2207

Practice Phone: 269-684-6777
Practice Fax: 269-683-5384