Provider Demographics
NPI:1386663425
Name:KINZLER, GORDON JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:JAMES
Last Name:KINZLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:929 NEWTON AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-3772
Mailing Address - Country:US
Mailing Address - Phone:630-545-9739
Mailing Address - Fax:630-545-9514
Practice Address - Street 1:1200 S YORK RD
Practice Address - Street 2:SUITE 4290
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5626
Practice Address - Country:US
Practice Address - Phone:630-758-8600
Practice Address - Fax:630-758-8603
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-071519208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL951041Medicare ID - Type Unspecified
ILE91487Medicare UPIN