Provider Demographics
NPI:1770512113
Name:HINES, RICHARD L (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:HINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5515 CLEVELAND AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-9670
Mailing Address - Country:US
Mailing Address - Phone:269-429-6604
Mailing Address - Fax:269-429-1715
Practice Address - Street 1:5515 CLEVELAND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-9670
Practice Address - Country:US
Practice Address - Phone:269-429-6604
Practice Address - Fax:269-429-1715
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051347208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1013403OtherCIGNA
MI3501103401OtherBLUE CROSS
MI370004516OtherRAILROAD MEDICARE
MI2893906Medicaid
MI12-31140OtherPHP
MI12-31140OtherPHP
MI3501103401OtherBLUE CROSS
MI2893906Medicaid