Provider Demographics
NPI:1760592414
Name:TIN, MAUNG MAUNG (MD)
Entity Type:Individual
Prefix:
First Name:MAUNG
Middle Name:MAUNG
Last Name:TIN
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 1:1770 EAST LAKE SHORE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3886
Mailing Address - Country:US
Mailing Address - Phone:217-233-1405
Mailing Address - Fax:217-233-1407
Practice Address - Street 1:1770 EAST LAKE SHORE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3886
Practice Address - Country:US
Practice Address - Phone:217-233-1405
Practice Address - Fax:217-233-1407
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
200846Medicare ID - Type Unspecified
G96492Medicare UPIN