Provider Demographics
NPI:1396878195
Name:LAL-TABAK, ARCHANA (MD)
Entity type:Individual
Prefix:DR
First Name:ARCHANA
Middle Name:
Last Name:LAL-TABAK
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 1:2716 PARK PLACE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1337
Mailing Address - Country:US
Mailing Address - Phone:847-425-9355
Mailing Address - Fax:847-424-9765
Practice Address - Street 1:2716 PARK PL
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1337
Practice Address - Country:US
Practice Address - Phone:847-425-9355
Practice Address - Fax:847-424-9765
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079471207Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine