Provider Demographics
NPI:1710900907
Name:TSINMAN, MICHAEL G (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:G
Last Name:TSINMAN
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 1:1625 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-5907
Mailing Address - Country:US
Mailing Address - Phone:847-962-7881
Mailing Address - Fax:847-537-2668
Practice Address - Street 1:1344 HORIZON TRL
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-4417
Practice Address - Country:US
Practice Address - Phone:847-962-7881
Practice Address - Fax:847-537-2668
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110421207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H56595Medicare UPIN
K18450Medicare ID - Type Unspecified