Provider Demographics
NPI:1063412062
Name:MYINT, WIN (MD)
Entity type:Individual
Prefix:
First Name:WIN
Middle Name:
Last Name:MYINT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4936 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2504
Mailing Address - Country:US
Mailing Address - Phone:708-424-3088
Mailing Address - Fax:708-424-5497
Practice Address - Street 1:4936 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2504
Practice Address - Country:US
Practice Address - Phone:708-424-3088
Practice Address - Fax:708-424-5497
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081896Medicaid
ILK45444Medicare PIN
ILE74328Medicare UPIN
IL036081896Medicaid