Individual
MICHAEL A KINZER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2200 RANDALLIA DR, FORT WAYNE, IN 46805-4638
(260) 373-4731
Mailing address
3707 NEW VISION DR, FORT WAYNE, IN 46845-1702
(260) 471-9466
(260) 484-5919
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
019169
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000092605
ANTHEM
IN
01
—
1484
PHP
IN
05
—
2100649
—
OH
05
—
4249815100
—
MI
Enumeration date
06/03/2006
Last updated
07/08/2007
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