Provider Demographics
NPI:1811974314
Name:TARTOF, DAVID (MD, PHD, INC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:TARTOF
Suffix:
Gender:M
Credentials:MD, PHD, INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 S KIMBARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1618
Mailing Address - Country:US
Mailing Address - Phone:312-315-5115
Mailing Address - Fax:312-986-8694
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:DOCTORS OFFICE CENTER - 2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-315-5115
Practice Address - Fax:312-986-8694
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036044364207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036044364Medicaid
IL036044364Medicaid
IL541910Medicare PIN
ILK11888Medicare ID - Type UnspecifiedGROUP 950150