Individual
MARK ROBERT WINKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
655 KENMOOR AVE SE, SUITE A, GRAND RAPIDS, MI 49546-8622
(616) 575-1212
(616) 575-1219
Mailing address
655 KENMOOR AVE SE, SUITE A, GRAND RAPIDS, MI 49546-8622
(616) 575-1212
(616) 575-1219
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
MW075576
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0D11035
BLUE CROSS BLUE SHIELD
MI
01
—
40015120
RAILROAD MEDICARE
MI
05
—
4212922
—
MI
Enumeration date
07/18/2006
Last updated
07/21/2008
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