Provider Demographics
NPI:1447242334
Name:HINDMAN, DEREK C (DPM)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:C
Last Name:HINDMAN
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 1:11465 SPRINGFIELD PIKE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3525
Mailing Address - Country:US
Mailing Address - Phone:513-671-2555
Mailing Address - Fax:513-671-0135
Practice Address - Street 1:11465 SPRINGFIELD PIKE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-3525
Practice Address - Country:US
Practice Address - Phone:513-671-2555
Practice Address - Fax:513-671-0135
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2948213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00424972OtherRAILROAD MEDICARE
OH0262880Medicaid
OH4139973Medicare PIN