MEDICARE: WAYNE K KINNING M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	WK045823	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0202507821	OTHER	MI	BC/BS OF MICHIGAN
2	105277	OTHER	MI	CARE CHOICE HOM
3	0656060	OTHER	MI	HEALTHPLUS OF MICHIGAN
4	105277	OTHER	MI	PREFERRED CHOICE PPO
5	4294670	OTHER	MI	AETNA
6	B44167	OTHER	MI	HEALTH ALLIANCE PLAN
7	1002468	OTHER	MI	MCLAREN HEALTH PLAN/ADVAN
8	107685	OTHER	MI	GREAT LAKES HEALTH PLAN
9	382237803108	OTHER	MI	COMMUNITY CHOICE
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	C3728	OTHER	MI	M-CARE

General Provider Information

NPI Number	:	1598736365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE K KINNING M.D.

Provider Business Mailing Address
First Line	:	5020 W BRISTOL RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-2919
Country	:	US
Telephone Number	:	810-732-1620
Fax Number	:	810-732-8559

Provider Business Practice Location Address
First Line	:	5020 W BRISTOL RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-2919
Country	:	US
Telephone Number	:	810-732-1620
Fax Number	:	810-732-8559

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	11/27/2007

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Directions to “ WAYNE K KINNING M.D.” Practice Location

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