Provider Demographics
NPI:1902861156
Name:MUSKWE, TINOFA O (MD)
Entity Type:Individual
Prefix:DR
First Name:TINOFA
Middle Name:O
Last Name:MUSKWE
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:PO BOX 678547
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8547
Mailing Address - Country:US
Mailing Address - Phone:877-794-2284
Mailing Address - Fax:804-612-5201
Practice Address - Street 1:951 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-3762
Practice Address - Country:US
Practice Address - Phone:228-207-1785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-35590207RC0200X
MS20598207RP1001X, 207RC0200X, 207RS0012X
IL036129400207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H19852OtherUPIN
MS7973581Medicaid
IAI17380OtherMEDICARE GROUP #
IA0491951Medicaid
IA2442517Medicaid
IAI17381Medicare PIN