Provider Demographics
NPI:1275515561
Name:VINCH, CRAIG S (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:S
Last Name:VINCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CRAIG
Other - Middle Name:S
Other - Last Name:VINCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:340 W LINCOLN ST
Mailing Address - Street 2:STE. 400
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1900
Mailing Address - Country:US
Mailing Address - Phone:618-233-6044
Mailing Address - Fax:618-233-5195
Practice Address - Street 1:340 W LINCOLN ST
Practice Address - Street 2:STE. 400
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1900
Practice Address - Country:US
Practice Address - Phone:618-233-6044
Practice Address - Fax:618-233-5195
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160974208D00000X
IL036136030207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036136030Medicaid
ILP01374239OtherRAILROAD
MA3198626Medicaid
IL036136030Medicaid
G62217Medicare UPIN
MAA29797Medicare PIN