MEDICARE: JOHN L. ZINKEL MD, PC

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	174400000X	Specialist	4301048627	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932381571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN L. ZINKEL MD, PC

Provider Business Mailing Address
First Line	:	21605 E 11 MILE RD
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-1636
Country	:	US
Telephone Number	:	586-774-4600
Fax Number	:	586-774-4603

Provider Business Practice Location Address
First Line	:	21605 E 11 MILE RD
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-1636
Country	:	US
Telephone Number	:	586-774-4600
Fax Number	:	586-774-4603

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN LLOYD ZINKEL
Credential	:	MD, PHD
Telephone Number	:	586-774-4600

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	06/14/2021

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