Basic Information
| Provider Information | |||||||||
| NPI: | 1184006611 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINNING | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | WAYNE | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1675 LEAHY ST STE 324B | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494425500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316722870 | ||||||||
| FaxNumber: | 2317281675 | ||||||||
| Practice Location | |||||||||
| Address1: | 1675 LEAHY ST STE 324B | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494425500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316728700 | ||||||||
| FaxNumber: | 2317281675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2015 | ||||||||
| LastUpdateDate: | 06/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5101021955 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 5101021955 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.