Provider Demographics
NPI:1700839529
Name:KINZER, STEVEN D (PA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:D
Last Name:KINZER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2454 KIPLING AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-6650
Mailing Address - Country:US
Mailing Address - Phone:513-981-6784
Mailing Address - Fax:513-853-4095
Practice Address - Street 1:2454 KIPLING AVE
Practice Address - Street 2:STE 120
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-6650
Practice Address - Country:US
Practice Address - Phone:513-981-6784
Practice Address - Fax:513-853-4095
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50000659363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00892986OtherMEDICARE RR
OHP00892986OtherMEDICARE RR
OHS57681Medicare UPIN