Provider Demographics
NPI:1427046531
Name:MYINT, ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:MYINT
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 1:800 EAST CARPENTER STREET
Mailing Address - Street 2:ROOM 2K64
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62769-0001
Mailing Address - Country:US
Mailing Address - Phone:217-525-5643
Mailing Address - Fax:217-544-2521
Practice Address - Street 1:800 EAST CARPENTER STREET
Practice Address - Street 2:ROOM 2K64
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62769-0001
Practice Address - Country:US
Practice Address - Phone:217-525-5643
Practice Address - Fax:217-544-2521
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100486207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL104409OtherHEALTHLINK GROUP NUMBER
ILL031806OtherTRICARE
IL32490OtherPERSONAL CARE
IL08415040OtherBLUE CROSS BLUE SHIELD
IL085972OtherHEALTH ALLIANCE NUMBER
IL036100486Medicaid
IL133279400OtherUS DEPT OF LABOR
IL104409OtherHEALTHLINK UPIN NUMBER
IL08415040OtherBLUE CROSS BLUE SHIELD
IL104409OtherHEALTHLINK UPIN NUMBER
IL32490OtherPERSONAL CARE
ILL98649Medicare ID - Type UnspecifiedMEDICARE PART B