Provider Demographics
NPI:1336227503
Name:GUREVICH, TAMARA (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:
Last Name:GUREVICH
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 1:150 W HALF DAY RD
Mailing Address - Street 2:SUIT 101
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6591
Mailing Address - Country:US
Mailing Address - Phone:847-821-1070
Mailing Address - Fax:847-821-1126
Practice Address - Street 1:150 W HALF DAY RD
Practice Address - Street 2:SUIT 101
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6591
Practice Address - Country:US
Practice Address - Phone:847-821-7010
Practice Address - Fax:847-821-1126
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104844208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00080504OtherRR MC
IL036104844Medicaid
ILDD7475OtherRRMC
ILDE1545OtherRRMC
ILP00080504OtherRR MC
ILDD7475OtherRRMC
IL212056Medicare PIN
IL211963Medicare PIN
ILK19958Medicare PIN