Provider Demographics
NPI:1003900556
Name:TABACK, ERIN MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MICHELLE
Last Name:TABACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1107 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1803
Mailing Address - Country:US
Mailing Address - Phone:708-383-2900
Mailing Address - Fax:708-383-2969
Practice Address - Street 1:1107 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1803
Practice Address - Country:US
Practice Address - Phone:708-383-2900
Practice Address - Fax:708-383-2969
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-098343208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-098343OtherIL LICENSE
27-3676211OtherTAX ID NUMBER