Provider Demographics
NPI:1992743637
Name:KINNE, MARK T (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:KINNE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7905 CALUMET AVE
Mailing Address - Street 2:FRANCISCAN HAMMOND CLINIC LLC
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1215
Mailing Address - Country:US
Mailing Address - Phone:219-836-7214
Mailing Address - Fax:219-365-9037
Practice Address - Street 1:7905 CALUMET AVE
Practice Address - Street 2:FRANCISCAN HAMMOND CLINIC LLC
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1215
Practice Address - Country:US
Practice Address - Phone:219-836-7214
Practice Address - Fax:219-365-9037
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2012-10-26
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Provider Licenses
StateLicense IDTaxonomies
IN01028626A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100258410AMedicaid
INE03899Medicare UPIN
IN100258410AMedicaid
IN473060WWWMedicare ID - Type Unspecified