Provider Demographics
NPI:1790868487
Name:TINKLER, MICHAEL R (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:TINKLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:171 GRANDVIEW AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2519
Mailing Address - Country:US
Mailing Address - Phone:203-755-2214
Mailing Address - Fax:203-596-1133
Practice Address - Street 1:171 GRANDVIEW AVE
Practice Address - Street 2:STE 105
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2519
Practice Address - Country:US
Practice Address - Phone:203-755-2214
Practice Address - Fax:203-596-1133
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT030371207P00000X, 207R00000X, 207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E37718Medicare UPIN