Provider Demographics
NPI:1679551493
Name:TINKOFF, GLEN (MD)
Entity type:Individual
Prefix:DR
First Name:GLEN
Middle Name:
Last Name:TINKOFF
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 1:11100 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1716
Mailing Address - Country:US
Mailing Address - Phone:216-844-8088
Mailing Address - Fax:216-201-5504
Practice Address - Street 1:20800 HARVARD RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HIGHLAND HILLS
Practice Address - State:OH
Practice Address - Zip Code:44122-7251
Practice Address - Country:US
Practice Address - Phone:216-358-2156
Practice Address - Fax:216-201-7880
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100039772086S0102X
OH35.1300042086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE402950C63Medicare PIN
DEE13004Medicare UPIN