Provider Demographics
NPI:1265447676
Name:SCOLIN, TATIANA (MD,)
Entity Type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:
Last Name:SCOLIN
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 1:201 E STRONG ST
Mailing Address - Street 2:SUITE #6
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-2979
Mailing Address - Country:US
Mailing Address - Phone:847-215-5222
Mailing Address - Fax:
Practice Address - Street 1:201 E STRONG ST
Practice Address - Street 2:SUITE #6
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-2979
Practice Address - Country:US
Practice Address - Phone:847-215-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-096565208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096565Medicaid