MEDICARE: DR. ALEXANDER TENNYSON HINCKLEY D.O.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	5101020374	MI

General Provider Information

NPI Number	:	1982049524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER TENNYSON HINCKLEY D.O.

Provider Business Mailing Address
First Line	:	3950 HOLLYWOOD RD STE 270
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-9158
Country	:	US
Telephone Number	:	269-983-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3950 HOLLYWOOD RD STE 270
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-9158
Country	:	US
Telephone Number	:	269-983-0500
Fax Number	:	269-429-2240

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

Provider Enumeration Date	:	05/09/2013
Last Update Date	:	07/23/2021

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Directions to “ DR. ALEXANDER TENNYSON HINCKLEY D.O.” Practice Location

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