Provider Demographics
NPI:1518359991
Name:RODRIGUE TINFANG MD FAMILY HEALTH LTD
Entity Type:Organization
Organization Name:RODRIGUE TINFANG MD FAMILY HEALTH LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODRIGUE
Authorized Official - Middle Name:MEYOU
Authorized Official - Last Name:TINFANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-977-0196
Mailing Address - Street 1:4909 W DIVISION ST STE 503
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-3161
Mailing Address - Country:US
Mailing Address - Phone:773-626-8833
Mailing Address - Fax:773-626-1635
Practice Address - Street 1:4909 W DIVISION ST
Practice Address - Street 2:SUITE 503
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-3161
Practice Address - Country:US
Practice Address - Phone:773-626-8833
Practice Address - Fax:773-626-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114443261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114443Medicaid
IL036114443Medicaid