Provider Demographics
NPI:1235227117
Name:TIRONA, REYNALDO ENCARNACION (MD)
Entity Type:Individual
Prefix:MR
First Name:REYNALDO
Middle Name:ENCARNACION
Last Name:TIRONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9223 W ST FRANCIS ROAD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423
Mailing Address - Country:US
Mailing Address - Phone:815-806-3111
Mailing Address - Fax:815-464-2621
Practice Address - Street 1:1400 W PARK ST
Practice Address - Street 2:SUITE D2248
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801
Practice Address - Country:US
Practice Address - Phone:217-337-3738
Practice Address - Fax:217-337-4569
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
C37387Medicare UPIN
ILK19841Medicare ID - Type Unspecified