Provider Demographics
NPI:1033174636
Name:ZINKEL, JOHN LLOYD (MD, PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LLOYD
Last Name:ZINKEL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 UNIVERSITY PL
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1636
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:ST 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
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048627207T00000X
OH35 050159207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1405016511OtherBCBSM
MAE89394OtherHAP
MI2961425Medicaid
MI0506625Medicare ID - Type Unspecified
MI2961425Medicaid