Provider Demographics
NPI:1912129735
Name:DR ELTON X TINSLEY & ASSOCIATES INC
Entity Type:Organization
Organization Name:DR ELTON X TINSLEY & ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELTON
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:TINSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-222-0030
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL360793252086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01607698OtherBLUE CROSS BLUE SHIELD
IL036079325Medicaid
IL01607698OtherBLUE CROSS BLUE SHIELD