Basic Information
| Provider Information | |||||||||
| NPI: | 1588850879 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LWIN | ||||||||
| FirstName: | TIN | ||||||||
| MiddleName: | MAY | ||||||||
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| OtherLastName: | LWIN | ||||||||
| OtherFirstName: | TIN | ||||||||
| OtherMiddleName: | MAY | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4747 W 31ST PL | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853647424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308640001 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2400 S AVE A | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853647127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283361441 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2007 | ||||||||
| LastUpdateDate: | 02/22/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 125050612 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 41676 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.