Provider Demographics
NPI:1760545289
Name:UTSET, TAMMY O (MD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:O
Last Name:UTSET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5841 S MARYLAND AVE # MC1099
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-702-6885
Mailing Address - Fax:773-702-8702
Practice Address - Street 1:5841 S MARYLAND AVE # MC1099
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-6885
Practice Address - Fax:773-702-8702
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2012-09-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036092270207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099270Medicaid
IL036099270Medicaid