MEDICARE: DR. THOMAS ZINK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	R2C88MD	MO
2	2083P0901X	Public Health & General Preventive Medicine Physician	R2C88MD	MO
3	208D00000X	General Practice Physician	R2C88MD	MO

General Provider Information

NPI Number	:	1083949648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS ZINK M.D.

Provider Business Mailing Address
First Line	:	3545 LAFAYETTE AVE
Second Line	:	SUITE 400
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-1314
Country	:	US
Telephone Number	:	215-681-3433
Fax Number	:

Provider Business Practice Location Address
First Line	:	3545 LAFAYETTE AVE
Second Line	:	SUITE 400
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-1314
Country	:	US
Telephone Number	:	215-681-3433
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2009
Last Update Date	:	10/14/2009

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