Provider Demographics
NPI:1710374434
Name:PERRY, TAMARA MARSHALL (MD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:MARSHALL
Last Name:PERRY
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 1:2913 N COMMONWEALTH AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6211
Mailing Address - Country:US
Mailing Address - Phone:773-665-3080
Mailing Address - Fax:
Practice Address - Street 1:2913 N COMMONWEALTH AVE FL 5
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6211
Practice Address - Country:US
Practice Address - Phone:773-665-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036145824207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology