Provider Demographics
NPI:1508139262
Name:TACHAUER, ALESSANDRA MARINELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALESSANDRA
Middle Name:MARINELLA
Last Name:TACHAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALESSANDRA
Other - Middle Name:MARINELLA
Other - Last Name:TACHAUER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1901 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3714
Mailing Address - Country:US
Mailing Address - Phone:312-864-6072
Mailing Address - Fax:312-864-9011
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-6034
Practice Address - Country:US
Practice Address - Phone:312-864-6072
Practice Address - Fax:312-864-9011
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360903912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL498596Medicare UPIN
IL001678957Medicare PIN