Provider Demographics
NPI:1215989702
Name:YEN, TINA W (MD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:W
Last Name:YEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:SURGICAL ONCOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-5020
Mailing Address - Fax:414-805-5771
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:SURGICAL ONCOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-5020
Practice Address - Fax:414-805-5771
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47210208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
029906261YOtherHUMANA
WI1215989702Medicaid
0074Q73601Medicare ID - Type Unspecified
WI68086 1163Medicare PIN
H76230Medicare UPIN