Provider Demographics
NPI:1225478191
Name:TSAMBARLIS, ALLISON ASAKO (MD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:ASAKO
Last Name:TSAMBARLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:ASAKO
Other - Last Name:PRATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1846 W ARMITAGE AVE UNIT 1W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1059
Mailing Address - Country:US
Mailing Address - Phone:909-730-7338
Mailing Address - Fax:
Practice Address - Street 1:2355 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3837
Practice Address - Country:US
Practice Address - Phone:773-254-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125066024207V00000X
MI4301103685282E00000X
IL036143806207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036143806Medicaid