Provider Demographics
NPI:1073711966
Name:HAINLINE, BRYAN CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:CHRISTOPHER
Last Name:HAINLINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1213
Mailing Address - Country:US
Mailing Address - Phone:765-962-2020
Mailing Address - Fax:765-966-2975
Practice Address - Street 1:1900 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1213
Practice Address - Country:US
Practice Address - Phone:765-962-2020
Practice Address - Fax:765-966-2975
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059329A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200903900Medicaid
OH3096144Medicaid
INP00627728OtherMEDICARE ID
OHP00914600Medicare PIN
OH4309861Medicare PIN
IN200903900Medicaid
IN217840IMedicare PIN
INP00627728OtherMEDICARE ID