MEDICARE: DR. CRAIG S VINCH 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	208D00000X	General Practice Physician	160974	MA
2	207RC0000X	Cardiovascular Disease Physician	036136030	IL

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
2	P01374239	OTHER	IL	RAILROAD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275515561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG S VINCH MD

Provider Business Mailing Address
First Line	:	340 W LINCOLN ST
Second Line	:	STE. 400
City	:	BELLEVILLE
State	:	IL
Zip	:	62220-1900
Country	:	US
Telephone Number	:	618-233-6044
Fax Number	:	618-233-5195

Provider Business Practice Location Address
First Line	:	340 W LINCOLN ST
Second Line	:	STE. 400
City	:	BELLEVILLE
State	:	IL
Zip	:	62220-1900
Country	:	US
Telephone Number	:	618-233-6044
Fax Number	:	618-233-5195

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	04/17/2017

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