Provider Demographics
NPI:1396910956
Name:RICHARD HAINER
Entity type:Organization
Organization Name:RICHARD HAINER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-601-4240
Mailing Address - Street 1:1349 S ROCHESTER RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3150
Mailing Address - Country:US
Mailing Address - Phone:248-601-4240
Mailing Address - Fax:248-601-4234
Practice Address - Street 1:1349 S ROCHESTER RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3150
Practice Address - Country:US
Practice Address - Phone:248-601-4240
Practice Address - Fax:248-601-4234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056609208200000X, 207XS0106X, 335E00000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2406337442OtherBCBBSM
MI1821017963OtherINDIVIDUAL NPI
MIRH056609OtherSTATE LICENSE
MI0F37932OtherBCBSM
MIRH056609OtherSTATE LICENSE
MI0N15120Medicare PIN