Healthcare Provider Details

I. General information

NPI: 1891751269
Provider Name (Legal Business Name): SOPHIA M ZINKOVSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SOPHIA MICHAEL ZINKOVSKY MD

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 S HILLSIDE ST
WICHITA KS
67211-2154
US

IV. Provider business mailing address

144 S HILLSIDE ST
WICHITA KS
67211-2154
US

V. Phone/Fax

Practice location:
  • Phone: 316-682-9900
  • Fax: 316-682-0311
Mailing address:
  • Phone: 316-682-9900
  • Fax: 316-682-0311

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:
Title or Position:
Credential:
Phone: