Provider Demographics
NPI:1245466523
Name:HINSHAW, MARK WALDO (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:WALDO
Last Name:HINSHAW
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1000 PARCHMENT DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3663
Mailing Address - Country:US
Mailing Address - Phone:616-957-9197
Mailing Address - Fax:616-957-2409
Practice Address - Street 1:1000 PARCHMENT DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3663
Practice Address - Country:US
Practice Address - Phone:616-957-9197
Practice Address - Fax:616-957-2409
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010305382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB47785Medicare UPIN