Provider Demographics
NPI:1598736365
Name:KINNING, WAYNE K (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:K
Last Name:KINNING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5020 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2919
Mailing Address - Country:US
Mailing Address - Phone:810-732-1620
Mailing Address - Fax:810-732-8559
Practice Address - Street 1:5020 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2919
Practice Address - Country:US
Practice Address - Phone:810-732-1620
Practice Address - Fax:810-732-8559
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIWK0458232086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0202507821OtherBC/BS OF MICHIGAN
MI105277OtherCARE CHOICE HOM
MI0656060OtherHEALTHPLUS OF MICHIGAN
MI105277OtherPREFERRED CHOICE PPO
MI4294670OtherAETNA
MIB44167OtherHEALTH ALLIANCE PLAN
MI1002468OtherMCLAREN HEALTH PLAN/ADVAN
MI107685OtherGREAT LAKES HEALTH PLAN
MI382237803108OtherCOMMUNITY CHOICE
MI1428625Medicaid
MIC3728OtherM-CARE
MI105277OtherCARE CHOICE HOM
MIB44167Medicare UPIN