MEDICARE: VINNETTE THERESA FORDE MD

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	207R00000X	Internal Medicine Physician	36273	KY
2	207R00000X	Internal Medicine Physician	036163633	IL
3	208M00000X	Hospitalist Physician	36273	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033174164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINNETTE THERESA FORDE MD

Provider Business Mailing Address
First Line	:	200 E CHESTNUT ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2356
Country	:	US
Telephone Number	:	859-221-0275
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 E CHESTNUT ST APT 1516
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2328
Country	:	US
Telephone Number	:	859-221-0275
Fax Number	:

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	08/29/2025

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