Provider Demographics
NPI:1134206576
Name:HINCHMAN, KEARN DAVID (DO)
Entity type:Individual
Prefix:
First Name:KEARN
Middle Name:DAVID
Last Name:HINCHMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11042 BIRCH LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635
Mailing Address - Country:US
Mailing Address - Phone:574-258-6316
Mailing Address - Fax:574-258-6307
Practice Address - Street 1:53779 GENERATIONS DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635
Practice Address - Country:US
Practice Address - Phone:574-258-6316
Practice Address - Fax:574-258-6307
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH14412084P0800X
IN020014232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F63231Medicare UPIN
IN162470Medicare ID - Type Unspecified