Provider Demographics
NPI:1659549731
Name:KINEL FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:KINEL FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISTIAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KINEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-798-8570
Mailing Address - Street 1:8880 W. SUNSET RD,
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148
Mailing Address - Country:US
Mailing Address - Phone:702-798-8570
Mailing Address - Fax:702-798-8518
Practice Address - Street 1:8880 W. SUNSET RD,
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148
Practice Address - Country:US
Practice Address - Phone:702-798-8570
Practice Address - Fax:702-798-8518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
V38539Medicare PIN