1598736365 NPI number — WAYNE K KINNING M.D.

Table of content: WAYNE K KINNING M.D. (NPI 1598736365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598736365 NPI number — WAYNE K KINNING M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KINNING
Provider First Name:
WAYNE
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598736365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5020 W BRISTOL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48507-2919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-732-1620
Provider Business Mailing Address Fax Number:
810-732-8559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5020 W BRISTOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48507-2919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-732-1620
Provider Business Practice Location Address Fax Number:
810-732-8559
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  WK045823 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0202507821 . This is a "BC/BS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 105277 . This is a "CARE CHOICE HOM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0656060 . This is a "HEALTHPLUS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 105277 . This is a "PREFERRED CHOICE PPO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4294670 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: B44167 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1002468 . This is a "MCLAREN HEALTH PLAN/ADVAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 107685 . This is a "GREAT LAKES HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382237803108 . This is a "COMMUNITY CHOICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1428625 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: C3728 . This is a "M-CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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