Provider Demographics
NPI:1932381571
Name:JOHN L. ZINKEL MD, PC
Entity type:Organization
Organization Name:JOHN L. ZINKEL MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:ZINKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:586-774-4600
Mailing Address - Street 1:21605 E 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1636
Mailing Address - Country:US
Mailing Address - Phone:586-774-4600
Mailing Address - Fax:586-774-4603
Practice Address - Street 1:21605 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1636
Practice Address - Country:US
Practice Address - Phone:586-774-4600
Practice Address - Fax:586-774-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048627174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2961425Medicaid
MI0506625Medicare PIN
MI2961425Medicaid