Provider Demographics
NPI:1033174164
Name:FORDE, VINNETTE THERESA (MD)
Entity Type:Individual
Prefix:
First Name:VINNETTE
Middle Name:THERESA
Last Name:FORDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VINNETTE
Other - Middle Name:T
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:200 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2356
Mailing Address - Country:US
Mailing Address - Phone:859-221-0275
Mailing Address - Fax:
Practice Address - Street 1:200 E CHESTNUT ST APT 1516
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2328
Practice Address - Country:US
Practice Address - Phone:859-221-0275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36273207R00000X, 208M00000X
IL036163633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64026156Medicaid
KY64026156Medicaid
KYK050150Medicare PIN