Provider Demographics
NPI:1740298942
Name:GINOS, STEVEN R (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:GINOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1005 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2834
Mailing Address - Country:US
Mailing Address - Phone:217-224-6423
Mailing Address - Fax:217-214-5874
Practice Address - Street 1:4800 MAINE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-5875
Practice Address - Country:US
Practice Address - Phone:217-224-6423
Practice Address - Fax:217-214-5874
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-072864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072864Medicaid
ILK19770Medicare ID - Type Unspecified
C42763Medicare UPIN
IL036072864Medicaid