Basic Information
| Provider Information | |||||||||
| NPI: | 1124434071 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KINZINGER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2121 N CRAYCROFT RD BLDG 5 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857122845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202968500 | ||||||||
| FaxNumber: | 5207332389 | ||||||||
| Practice Location | |||||||||
| Address1: | 2240 N HARBOR BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928352635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144474100 | ||||||||
| FaxNumber: | 7144471922 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2014 | ||||||||
| LastUpdateDate: | 10/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | MD60934004 | WA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 1124434071 | 05 | WA | MEDICAID |