Healthcare Provider Details

I. General information

NPI: 1770611055
Provider Name (Legal Business Name): WILFRIDO M. TINIO MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 10/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N EMERSON AVE
GREENWOOD IN
46143-8895
US

IV. Provider business mailing address

PO BOX 68952
INDIANAPOLIS IN
46268-0952
US

V. Phone/Fax

Practice location:
  • Phone: 317-881-3937
  • Fax: 317-870-0499
Mailing address:
  • Phone: 317-802-6304
  • Fax: 317-870-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILFRIDO M TINIO
Title or Position: OWNER
Credential: MD
Phone: 317-881-3937