Provider Demographics
NPI:1750469987
Name:WATTS, TABITHA A (MD)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:A
Last Name:WATTS
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:PO BOX 4645
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-4645
Mailing Address - Country:US
Mailing Address - Phone:312-451-5695
Mailing Address - Fax:312-264-0662
Practice Address - Street 1:1449 S MICHIGAN AVE # 1307
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2810
Practice Address - Country:US
Practice Address - Phone:888-437-2682
Practice Address - Fax:312-264-0662
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-108494208000000X, 2080P0204X
WI137-320208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics