Provider Demographics
NPI:1114226578
Name:GRANT, TAMILA (MD)
Entity Type:Individual
Prefix:
First Name:TAMILA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TAMILA
Other - Middle Name:
Other - Last Name:JEBAMONY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 443
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60690-0443
Mailing Address - Country:US
Mailing Address - Phone:708-831-8282
Mailing Address - Fax:
Practice Address - Street 1:8420 W BRYN MAWR AVE STE 300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3436
Practice Address - Country:US
Practice Address - Phone:312-933-4014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336098897207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology