Provider Demographics
NPI:1215151097
Name:HINSHAW, KEVIN D (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:HINSHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 MARTINGALE DR
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-8418
Mailing Address - Country:US
Mailing Address - Phone:314-604-4716
Mailing Address - Fax:855-274-9831
Practice Address - Street 1:2704 MARTINGALE DR
Practice Address - Street 2:
Practice Address - City:BERTHOUD
Practice Address - State:CO
Practice Address - Zip Code:80513-8418
Practice Address - Country:US
Practice Address - Phone:314-604-4716
Practice Address - Fax:855-274-9831
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0059066207W00000X
MO109644207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000013717Medicare PIN
MOG32704Medicare UPIN