Provider Demographics
NPI:1801974886
Name:ZINIS, KOSTA MARK (DO)
Entity type:Individual
Prefix:DR
First Name:KOSTA
Middle Name:MARK
Last Name:ZINIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:KOSTANTINE
Other - Middle Name:CHRIS
Other - Last Name:ZINIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-0600
Mailing Address - Country:US
Mailing Address - Phone:928-283-2501
Mailing Address - Fax:
Practice Address - Street 1:167 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045-0600
Practice Address - Country:US
Practice Address - Phone:928-283-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0036164207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00131665OtherRR MEDICARE PIN
AZTEZEE0YM9NOtherMEDICARE
AZ825101Medicaid
DB2526OtherRR MEDICARE GRP
70544OtherBC BSH
CO01371641Medicaid
CO01371641Medicaid