Provider Demographics
NPI:1932101151
Name:KINKOPF, EDWARD J (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:KINKOPF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2912 SPRINGBORO W
Mailing Address - Street 2:STE 201
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1674
Mailing Address - Country:US
Mailing Address - Phone:937-434-7353
Mailing Address - Fax:937-438-6569
Practice Address - Street 1:1989 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:STE 301
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-3858
Practice Address - Country:US
Practice Address - Phone:937-434-7353
Practice Address - Fax:937-438-6569
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2013-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34002998K207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOC03635OtherNATIONWIDE HEALTH PLAN
OH0480224Medicaid
OHD0299805OtherHUMANA/CHOICECARE
OH000000227873OtherUNICARE
OH080191713OtherRAILROAD MEDICARE
OH421534506074OtherCARESOURCE
OH000000227873OtherANTHEM
OH0120251OtherUNITED HEALTHCARE
OH2220377OtherAETNA
OH34002998OtherMEDICAL LICENSE
OHC02159Medicare UPIN
OHKI0501937Medicare PIN