Provider Demographics
NPI:1427023290
Name:FINK, JOHN GILMORE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GILMORE
Last Name:FINK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100559
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0559
Mailing Address - Country:US
Mailing Address - Phone:843-664-4300
Mailing Address - Fax:843-664-4308
Practice Address - Street 1:551 S SILVERBROOK DR
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3868
Practice Address - Country:US
Practice Address - Phone:262-334-8287
Practice Address - Fax:262-334-8497
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31307207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32001000Medicaid
F75133Medicare UPIN
WI32001000Medicaid
WI000267195Medicare PIN