Healthcare Provider Details

I. General information

NPI: 1669433488
Provider Name (Legal Business Name): JOSEPH EDMUND KINZEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 STONE PARK BLVD
SIOUX CITY IA
51104-3734
US

IV. Provider business mailing address

2720 STONE PARK BLVD
SIOUX CITY IA
51104-3734
US

V. Phone/Fax

Practice location:
  • Phone: 712-279-3789
  • Fax: 712-279-3613
Mailing address:
  • Phone: 712-279-3789
  • Fax: 712-279-3613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number28490
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28490
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: