Provider Demographics
NPI:1588794622
Name:TIOCO, JEFFREY MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MANUEL
Last Name:TIOCO
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 1:9136 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2907
Mailing Address - Country:US
Mailing Address - Phone:219-836-2225
Mailing Address - Fax:219-836-3158
Practice Address - Street 1:9132 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2907
Practice Address - Country:US
Practice Address - Phone:219-836-2225
Practice Address - Fax:219-836-3158
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054586A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
7195342OtherAETNA
IN000000207545OtherANTHEM
208965421EOtherUNICARE
IL90001346OtherBLUE CROSS BLUE SHIELD IL
208965421OtherFISERV
IL90001346OtherBLUE CROSS BLUE SHIELD IL
200041768Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IN000000207545OtherANTHEM
IN0399280001Medicare NSC