Provider Demographics
NPI:1619078755
Name:HINTZ, DAVID J (DPM INC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:HINTZ
Suffix:
Gender:M
Credentials:DPM INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 E BROAD ST
Mailing Address - Street 2:103
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6351
Mailing Address - Country:US
Mailing Address - Phone:440-323-9791
Mailing Address - Fax:440-323-5324
Practice Address - Street 1:1170 E BROAD ST
Practice Address - Street 2:103
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6351
Practice Address - Country:US
Practice Address - Phone:440-323-9791
Practice Address - Fax:440-323-5324
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001973-H213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0440722Medicaid
OH4043461Medicare PIN
OHT80491Medicare UPIN