Individual
RAYMOND E HINES III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
19110 DARVIN DR, SUITE C, MOKENA, IL 60448-8595
(708) 390-2290
(708) 390-2299
Mailing address
19110 DARVIN DR, SUITE C, MOKENA, IL 60448-8595
(708) 390-2290
(708) 390-2299
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085000929
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DO9194
RR MEDICARE
IL
Enumeration date
09/29/2006
Last updated
03/19/2010
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