Provider Demographics
NPI:1316171127
Name:HINZ, JESSIKA (DO)
Entity type:Individual
Prefix:
First Name:JESSIKA
Middle Name:
Last Name:HINZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 HIGHLAND BLVD
Mailing Address - Street 2:STE 5120
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6916
Mailing Address - Country:US
Mailing Address - Phone:406-414-4210
Mailing Address - Fax:
Practice Address - Street 1:937 HIGHLAND BLVD STE 5120
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6916
Practice Address - Country:US
Practice Address - Phone:406-414-4210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-134861207RI0200X
MT83697207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400148648OtherMEDICARE PTAN COOK COUNTY