Provider Demographics
NPI:1013171453
Name:CARRILLO, TAMI C (MD)
Entity type:Individual
Prefix:DR
First Name:TAMI
Middle Name:C
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TAMI
Other - Middle Name:C
Other - Last Name:MCHUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:CANCER TREATMENT CENTERS OF AMERICA
Mailing Address - Street 2:2361 PAYSPHERE CIRCLE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674
Mailing Address - Country:US
Mailing Address - Phone:800-322-9183
Mailing Address - Fax:
Practice Address - Street 1:CANCER TREATMENT CENTERS OF AMERICA
Practice Address - Street 2:2520 ELISHA AVE
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099
Practice Address - Country:US
Practice Address - Phone:800-322-9183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI609052085R0204X
IL036.1204562085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology