Provider Demographics
NPI:1457374340
Name:HINNERS, DEAN DWIGHT (DPM)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:DWIGHT
Last Name:HINNERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960-1508
Mailing Address - Country:US
Mailing Address - Phone:618-524-8146
Mailing Address - Fax:844-210-4810
Practice Address - Street 1:412 W 10TH ST
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960-1508
Practice Address - Country:US
Practice Address - Phone:618-524-8146
Practice Address - Fax:618-524-8146
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-003809213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016003809Medicaid
KY80001779Medicaid
IL5007390001Medicare NSC
KY80001779Medicaid
IL747370Medicare PIN