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General NPI Number Information
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NPI Number | 1043498678
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Entity Type | Organization
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Legal Business Name | GORDON J. KINZLER, M.D.,S.C.
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 1200 S YORK RD STE 4290
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City | ELMHURST
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State | IL
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Zip | 60126-5632
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Country | US
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Telephone | 630-758-8600
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Fax | 630-758-8603
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Provider Business Mailing Address
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Address Line | 1200 S YORK RD STE 4290
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City | ELMHURST
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State | IL
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Zip | 60126-5632
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Country | US
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Telephone | 630-758-8600
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Fax | 630-758-8603
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GORDON KINZLER
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Credential | M.D.
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Telephone | 630-758-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 036071519
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License Number State | IL
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