MEDICARE: DR. FEDERICO PASCUAL TINSAY MD, FAAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	41254	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1508809765	OTHER	MN	RED LAKE FACILITY NPI

General Provider Information

NPI Number	:	1841221892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FEDERICO PASCUAL TINSAY MD, FAAP

Provider Business Mailing Address
First Line	:	5743 EARLY PIONEER DR NW
Second Line	:
City	:	BEMIDJI
State	:	MN
Zip	:	56601-5953
Country	:	US
Telephone Number	:	218-755-9415
Fax Number	:

Provider Business Practice Location Address
First Line	:	15765 HOLSTEIN AVENUE
Second Line	:
City	:	REDLAKE
State	:	MN
Zip	:	56671-0497
Country	:	US
Telephone Number	:	218-679-3912
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	12/27/2007

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