Provider Demographics
NPI:1790487858
Name:HINES, SHAD M (DO)
Entity type:Individual
Prefix:
First Name:SHAD
Middle Name:M
Last Name:HINES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10914 E 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5636
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11900 E 12 MILE RD STE 205
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3499
Practice Address - Country:US
Practice Address - Phone:586-582-7034
Practice Address - Fax:586-582-7034
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2024-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program