Provider Demographics
NPI:1578839858
Name:KINKOPF, BRETT WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:WILLIAM
Last Name:KINKOPF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9674 CHERRY TREE DR
Mailing Address - Street 2:APT. 312
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-2773
Mailing Address - Country:US
Mailing Address - Phone:937-671-1167
Mailing Address - Fax:
Practice Address - Street 1:2600 SIXTH ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1702
Practice Address - Country:US
Practice Address - Phone:330-456-2695
Practice Address - Fax:330-588-8605
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.122391207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0102321Medicaid