Provider Demographics
NPI:1750002911
Name:SUMMERFIELD, TATUM
Entity type:Individual
Prefix:
First Name:TATUM
Middle Name:
Last Name:SUMMERFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4846
Mailing Address - Country:US
Mailing Address - Phone:571-789-9804
Mailing Address - Fax:
Practice Address - Street 1:347 S GLADSTONE AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4892
Practice Address - Country:US
Practice Address - Phone:630-892-6431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer