Individual
DR. TINA M MOLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-1285
(217) 366-6129
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-1326
(217) 366-6106
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036-122369
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200520830A
—
IN
01
—
279500
MEDICARE GROUP
IL
Enumeration date
07/18/2006
Last updated
01/06/2022
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