Basic Information
| Provider Information | |||||||||
| NPI: | 1942294533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HINKEBEIN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9905 SHELBYVILLE RD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402232907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024255166 | ||||||||
| FaxNumber: | 5023270526 | ||||||||
| Practice Location | |||||||||
| Address1: | 9905 SHELBYVILLE RD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402232907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024255166 | ||||||||
| FaxNumber: | 5023270526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2005 | ||||||||
| LastUpdateDate: | 09/13/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | 18007 | KY | N | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | 208000000X | 18007 | KY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 64180078 | 05 | KY | MEDICAID |