Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 35 050159 | OH |
Y | 207T00000X | Neurosurgeon | 4301048627 | MI |
NPI | 1033174636 |
---|---|
Provider Name | John Lloyd Zinkel |
First Address | Grosse Pointe, MI 48230-1636 |
Second Address | St Clair Shores, MI 48081-1636 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 14/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1405016511 | BCBSM (01) | MI |
2961425 | (05) | MI |
E89394 | (02) | MI |
E89394 | HAP (01) | MA |