Provider Demographics
NPI:1679514269
Name:HINZ, MICHAEL A (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:HINZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 EMERALD TER
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2312
Mailing Address - Country:US
Mailing Address - Phone:618-234-4608
Mailing Address - Fax:618-234-4451
Practice Address - Street 1:6 EMERALD TER
Practice Address - Street 2:SUITE 2
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2312
Practice Address - Country:US
Practice Address - Phone:618-234-4608
Practice Address - Fax:618-234-4451
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005238103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213775Medicare PIN