Healthcare Provider Details

I. General information

NPI: 1598103236
Provider Name (Legal Business Name): ALISON JENNIFER KINNING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 W BRISTOL RD
FLINT MI
48507
US

IV. Provider business mailing address

5020 W BRISTOL RD
FLINT MI
48507-2919
US

V. Phone/Fax

Practice location:
  • Phone: 810-732-1620
  • Fax: 810-732-8559
Mailing address:
  • Phone: 810-732-1620
  • Fax: 810-732-8559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number4301115232
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: