Provider Demographics
NPI:1104530179
Name:KINCAID, HILTON EDWARD
Entity type:Individual
Prefix:
First Name:HILTON
Middle Name:EDWARD
Last Name:KINCAID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 CLEARWATER BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-3925
Mailing Address - Country:US
Mailing Address - Phone:313-405-0833
Mailing Address - Fax:
Practice Address - Street 1:1220 CLEARWATER BLVD
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-3925
Practice Address - Country:US
Practice Address - Phone:313-405-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach