Provider Demographics
NPI:1548466030
Name:KINER, JASON LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:LAWRENCE
Last Name:KINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:
Practice Address - Street 1:5408 SALMON RIVER CT
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-8282
Practice Address - Country:US
Practice Address - Phone:561-373-6022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA761242084N0008X
MEMD209032084N0400X
MA2658082084N0400X
KY530282084N0400X
ARE-123652084N0400X
AZ589952084N0400X
FLME 1073272084N0400X
IN01082475A2084N0400X
WI61375-202084N0400X
VA01012680812084N0400X
NMTM2016-07962084N0400X
NC2016-009812084N0400X
NJ25MA107460002084N0400X
NV176962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine