Provider Demographics
NPI:1831143262
Name:HYINK, WENDELL J (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:J
Last Name:HYINK
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:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-0458
Mailing Address - Country:US
Mailing Address - Phone:269-684-0259
Mailing Address - Fax:269-684-0189
Practice Address - Street 1:31 N SAINT JOSEPH AVE
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2207
Practice Address - Country:US
Practice Address - Phone:269-684-1432
Practice Address - Fax:269-684-0259
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037510207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1356370241OtherGROUP NPI
MI050A111210OtherGROUP BCBS PIN
MI0M30900OtherMEDICARE GROUP PTAN
MI1831143262Medicaid
MIM30900008OtherMEDICARE INDIVIDUAL PTAN
MIWH037510OtherINDIVIDUAL BCBS LICENSE NUMBER