Provider Demographics
NPI:1043201072
Name:POWELL, TANYA M (MD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:M
Last Name:POWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 COMMERCE DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1546
Mailing Address - Country:US
Mailing Address - Phone:847-698-0600
Mailing Address - Fax:847-698-0601
Practice Address - Street 1:1700 LUTHER LN
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1270
Practice Address - Country:US
Practice Address - Phone:630-205-6612
Practice Address - Fax:847-698-0601
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361110222085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL778401OtherMEDICARE PROVIDER NUMBER
IL036111022Medicaid
ILP00138138OtherRAILROAD MEDICARE
IL558620OtherMEDICARE PROVIDER NUMBER
IL778401OtherMEDICARE PROVIDER NUMBER