Provider Demographics
NPI:1053354944
Name:HINZE, MICHELLE LYNN (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNN
Last Name:HINZE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 SAMSON WAY
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-4307
Mailing Address - Country:US
Mailing Address - Phone:402-331-6387
Mailing Address - Fax:402-331-6537
Practice Address - Street 1:2705 SAMSON WAY
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-4307
Practice Address - Country:US
Practice Address - Phone:402-331-6387
Practice Address - Fax:402-331-6537
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE306213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025518000Medicaid
NE100258518200Medicaid
NE10025518100Medicaid
NE099583OtherMEDIARE GROUP
NE10025640100Medicaid
NE1427348838OtherGROUP NPI: LOWER EXTREMITY SURGERY GROUP, LLC
NE099583OtherMEDIARE GROUP
NE1427348838OtherGROUP NPI: LOWER EXTREMITY SURGERY GROUP, LLC
NE100258518200Medicaid
NENA1914002Medicare PIN
NE10025640100Medicaid
NENA1914Medicare PIN