Provider Demographics
NPI:1891751269
Name:ZINKOVSKY, SOPHIA M (MD)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:M
Last Name:ZINKOVSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:MICHAEL
Other - Last Name:ZINKOVSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:144 S HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-2154
Mailing Address - Country:US
Mailing Address - Phone:316-682-9900
Mailing Address - Fax:316-682-0311
Practice Address - Street 1:144 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-2154
Practice Address - Country:US
Practice Address - Phone:316-682-9900
Practice Address - Fax:316-682-0311
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28830208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
274563042OtherTAX ID
KS100381950DMedicaid
274563042OtherTAX ID
H55949Medicare UPIN