Healthcare Provider Details

I. General information

NPI: 1700201852
Provider Name (Legal Business Name): THOMAS KINER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 02/10/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

4179 KINDRED WAY
LAKE ELMO MN
55042-8579
US

V. Phone/Fax

Practice location:
  • Phone: 651-253-6564
  • Fax:
Mailing address:
  • Phone: 651-253-6564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101258714
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: