Provider Demographics
NPI:1114908423
Name:KINZIGER, MARK STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEPHEN
Last Name:KINZIGER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1266 E SHERMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1847
Mailing Address - Country:US
Mailing Address - Phone:231-739-9009
Mailing Address - Fax:231-733-0566
Practice Address - Street 1:1266 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1847
Practice Address - Country:US
Practice Address - Phone:231-739-9009
Practice Address - Fax:231-733-0566
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301042307207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3247020Medicaid
MI3247020Medicaid
ON1390001Medicare ID - Type Unspecified