Individual
VINCENT MACINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1201 WOODDELL WAY STE B, MATTOON, IL 61938-1014
(217) 238-3000
(217) 238-3008
Mailing address
9225 HENNING LN, HENNEPIN, IL 61327-5026
(708) 369-2660
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110010584
VA
363A00000X
Physician Assistant
033144
NY
363A00000X
Physician Assistant
Primary
085008400
IL
363A00000X
Physician Assistant
10005092A
IN
363A00000X
Physician Assistant
15-03032
KS
363A00000X
Physician Assistant
2024049952
MO
363A00000X
Physician Assistant
25MP00899800
NJ
363A00000X
Physician Assistant
50.009240RX
OH
363A00000X
Physician Assistant
54322
CA
363A00000X
Physician Assistant
6289
TN
363A00000X
Physician Assistant
8220-23
WI
363A00000X
Physician Assistant
C0009755
MD
363A00000X
Physician Assistant
MA066292
PA
363A00000X
Physician Assistant
PA101183
MA
363A00000X
Physician Assistant
TPPA811
FL
Other
Enumeration date
01/08/2017
Last updated
03/05/2026
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