Provider Demographics
NPI:1245452259
Name:TINSLEY, ELTON XAVIER (MD)
Entity type:Individual
Prefix:DR
First Name:ELTON
Middle Name:XAVIER
Last Name:TINSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 804193
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-4103
Mailing Address - Country:US
Mailing Address - Phone:312-222-0030
Mailing Address - Fax:312-649-5808
Practice Address - Street 1:845 N MICHIGAN AVE
Practice Address - Street 2:SUITE 957W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2252
Practice Address - Country:US
Practice Address - Phone:312-222-0030
Practice Address - Fax:312-649-5808
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36079325208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01607698OtherBLUE CROSS BLUE SHIELD
IL01607698OtherBLUE CROSS BLUE SHIELD