Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 01063568A | IN |
NPI | 1013961382 |
---|---|
Provider Name | Robert Mark Kinn |
First Address | Detroit, MI 48278-1076 |
Second Address | Indianapolis, IN 46237-6345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 18/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200862080A | (05) | IN |
E65839 | (02) |