MEDICARE: DR. GLEN TINKOFF 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	2086S0102X	Surgical Critical Care Physician	C10003977	DE
2	2086S0102X	Surgical Critical Care Physician	35.130004	OH

General Provider Information

NPI Number	:	1679551493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLEN TINKOFF MD

Provider Business Mailing Address
First Line	:	11100 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1716
Country	:	US
Telephone Number	:	216-844-8088
Fax Number	:	216-201-5504

Provider Business Practice Location Address
First Line	:	20800 HARVARD RD
Second Line	:	2ND FLOOR
City	:	HIGHLAND HILLS
State	:	OH
Zip	:	44122-7251
Country	:	US
Telephone Number	:	216-358-2156
Fax Number	:	216-201-7880

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	11/06/2020

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