Provider Demographics
NPI:1114104528
Name:DAVID TARTOF MD, PHD, INC
Entity Type:Organization
Organization Name:DAVID TARTOF MD, PHD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TARTOF
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:312-315-5115
Mailing Address - Street 1:5511 S KIMBARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1618
Mailing Address - Country:US
Mailing Address - Phone:312-315-5115
Mailing Address - Fax:312-986-8694
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:DOCTORS OFFICE CENTER - 2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-315-5115
Practice Address - Fax:312-986-8694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036044364174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL541910Medicare PIN