Provider Demographics
NPI:1225235492
Name:MAHINAY, MICHAEL CONSTANCIO RESPICIO IV (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL CONSTANCIO
Middle Name:RESPICIO
Last Name:MAHINAY
Suffix:IV
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 YALE DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-7305
Mailing Address - Country:US
Mailing Address - Phone:812-549-6512
Mailing Address - Fax:
Practice Address - Street 1:1250 MAIN ST
Practice Address - Street 2:#1282
Practice Address - City:MOUNT VERNON
Practice Address - State:IN
Practice Address - Zip Code:47620
Practice Address - Country:US
Practice Address - Phone:812-549-6512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009818A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist