Healthcare Provider Details

I. General information

NPI: 1710282223
Provider Name (Legal Business Name): ZINKOVSKY PEDIATRICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 N RIDGE RD SUITE 100
WICHITA KS
67205-1227
US

IV. Provider business mailing address

106 N ASHLEY PARK
WICHITA KS
67212-6123
US

V. Phone/Fax

Practice location:
  • Phone: 316-462-6200
  • Fax:
Mailing address:
  • Phone: 316-773-6588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-28830
License Number StateKS

VIII. Authorized Official

Name: DR. SOPHIA M ZINKOVSKY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 316-773-6588