Provider Demographics
NPI:1104866573
Name:HINZE, MARC WILLIAM (MPT)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:WILLIAM
Last Name:HINZE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4613 W MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2645
Mailing Address - Country:US
Mailing Address - Phone:269-488-8360
Mailing Address - Fax:269-488-8359
Practice Address - Street 1:4613 W MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-2645
Practice Address - Country:US
Practice Address - Phone:269-488-8360
Practice Address - Fax:269-488-8359
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650C901900OtherBCBS
155812OtherGREAT LAKES HLTH PLAN
7173604OtherAETNA PIN
7173604OtherAETNA PIN
MI650C901900OtherBCBS
383148262OtherEIN-HEALTHCARE MIDWEST
MI0N74060004Medicare ID - Type Unspecified
MICA3050Medicare PIN