Provider Demographics
NPI:1033102272
Name:HINDERER, JON (DO)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:HINDERER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 HARVEY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-4274
Mailing Address - Country:US
Mailing Address - Phone:231-777-5906
Mailing Address - Fax:231-773-8904
Practice Address - Street 1:684 HARVEY ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-4274
Practice Address - Country:US
Practice Address - Phone:231-777-5906
Practice Address - Fax:231-773-8904
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007162207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE26076Medicare UPIN
MI0F16049Medicare ID - Type Unspecified