Provider Demographics
NPI:1982049524
Name:HINCKLEY, ALEXANDER TENNYSON (DO)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:TENNYSON
Last Name:HINCKLEY
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 1:3950 HOLLYWOOD RD STE 270
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9158
Mailing Address - Country:US
Mailing Address - Phone:269-983-0500
Mailing Address - Fax:
Practice Address - Street 1:3950 HOLLYWOOD RD STE 270
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9158
Practice Address - Country:US
Practice Address - Phone:269-983-0500
Practice Address - Fax:269-429-2240
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020374207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine