Provider Demographics
NPI:1427001825
Name:LATIMER, TOMITRA (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMITRA
Middle Name:
Last Name:LATIMER
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 1:467 W DEMING PL STE 600
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2898
Mailing Address - Country:US
Mailing Address - Phone:312-227-6450
Mailing Address - Fax:312-227-9441
Practice Address - Street 1:467 W DEMING PL STE 600
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2898
Practice Address - Country:US
Practice Address - Phone:123-227-6450
Practice Address - Fax:312-227-9441
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098985208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098985Medicaid
IL036098985Medicaid
G98578Medicare UPIN
IL036098985Medicaid