Provider Demographics
NPI:1083668404
Name:VINSON, TINA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:MARIA
Last Name:VINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S WASHINGTON ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7430
Mailing Address - Country:US
Mailing Address - Phone:630-527-5359
Mailing Address - Fax:630-527-5526
Practice Address - Street 1:801 S WASHINGTON ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7430
Practice Address - Country:US
Practice Address - Phone:630-527-5359
Practice Address - Fax:630-527-5526
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113577207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113577Medicaid
IL036113577Medicaid
ILK22893Medicare ID - Type Unspecified
IL2220936OtherBCBS
ILI45902Medicare UPIN
ILP00679773Medicare PIN