Provider Demographics
NPI:1003843517
Name:TAM, MARIA TERESA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA TERESA
Middle Name:
Last Name:TAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2845 N SHERIDAN RD
Mailing Address - Street 2:SUITE 902
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7227
Mailing Address - Country:US
Mailing Address - Phone:773-904-8641
Mailing Address - Fax:872-888-1206
Practice Address - Street 1:2845 N SHERIDAN RD
Practice Address - Street 2:STE 902
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-7227
Practice Address - Country:US
Practice Address - Phone:773-904-8641
Practice Address - Fax:872-888-1206
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093565207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093565Medicaid
IL1620171OtherBLUE CROSS BLUE SHIELD
IL036093565Medicaid
G84064Medicare UPIN