Provider Demographics
NPI:1437154614
Name:ZINN, THOMAS WILDER (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILDER
Last Name:ZINN
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 1:5800 FOXRIDGE DR
Mailing Address - Street 2:STE 240
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2338
Mailing Address - Country:US
Mailing Address - Phone:913-261-3153
Mailing Address - Fax:913-262-3295
Practice Address - Street 1:8929 PARALLEL PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1689
Practice Address - Country:US
Practice Address - Phone:913-596-4862
Practice Address - Fax:913-596-4635
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-140182085R0202X
MO20050099482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100200980BMedicaid
MO200837417Medicaid
KS100200980Medicaid
MOJ965612BMedicare PIN
KSW245612Medicare PIN
KS100200980Medicaid
KS104368Medicare PIN
MOJ965612Medicare PIN
KSJ965612AMedicare PIN