Provider Demographics
NPI:1750519807
Name:TARKOWSKI, ERIC MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MATTHEW
Last Name:TARKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 W HUBBARD ST
Mailing Address - Street 2:4002
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4637
Mailing Address - Country:US
Mailing Address - Phone:847-340-0201
Mailing Address - Fax:
Practice Address - Street 1:676 N SAINT CLAIR ST
Practice Address - Street 2:SUITE 800
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2927
Practice Address - Country:US
Practice Address - Phone:312-695-3755
Practice Address - Fax:312-269-5564
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094373207R00000X, 2085R0202X
IL036.1353132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine