Provider Demographics
NPI:1083909956
Name:KADOW, TIFFANY R (MD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:R
Last Name:KADOW
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 1:680 NORTH LAKE SHORE DRIVE
Mailing Address - Street 2:1000
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-695-0665
Mailing Address - Fax:
Practice Address - Street 1:27650 FERRY RD
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555
Practice Address - Country:US
Practice Address - Phone:630-225-2663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-18
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT199600207X00000X
IL0361469052086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery