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General NPI Number Information
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NPI Number | 1245452259
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Entity Type | Individual
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Provider Name | ELTON XAVIER TINSLEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 845 N MICHIGAN AVE SUITE 957W
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City | CHICAGO
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State | IL
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Zip | 60611-2252
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Country | US
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Telephone | 312-222-0030
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Fax | 312-649-5808
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Provider Business Mailing Address
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Address Line | PO BOX 804193
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City | CHICAGO
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State | IL
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Zip | 60680-4103
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Country | US
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Telephone | 312-222-0030
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Fax | 312-649-5808
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 36079325
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License Number State | IL
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