Provider Demographics
NPI:1043498678
Name:GORDON J. KINZLER, M.D.,S.C.
Entity Type:Organization
Organization Name:GORDON J. KINZLER, M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:KINZLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-758-8600
Mailing Address - Street 1:1200 S YORK RD STE 4290
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5632
Mailing Address - Country:US
Mailing Address - Phone:630-758-8600
Mailing Address - Fax:630-758-8603
Practice Address - Street 1:1200 S YORK RD STE 4290
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5632
Practice Address - Country:US
Practice Address - Phone:630-758-8600
Practice Address - Fax:630-758-8603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071519208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE91487Medicare UPIN