Basic Information
| Provider Information | |||||||||
| NPI: | 1841221892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TINSAY | ||||||||
| FirstName: | FEDERICO | ||||||||
| MiddleName: | PASCUAL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, FAAP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5743 EARLY PIONEER DR NW | ||||||||
| Address2: | |||||||||
| City: | BEMIDJI | ||||||||
| State: | MN | ||||||||
| PostalCode: | 566015953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187559415 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15765 HOLSTEIN AVENUE | ||||||||
| Address2: | |||||||||
| City: | REDLAKE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 566710497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186793912 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 12/27/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | 41254 | MN | Y | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1508809765 | 01 | MN | RED LAKE FACILITY NPI | OTHER |