Provider Demographics
NPI:1881609642
Name:WYSE, TAMARA B (MD)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:B
Last Name:WYSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:900 SKOKIE BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4012
Mailing Address - Country:US
Mailing Address - Phone:847-497-2020
Mailing Address - Fax:847-497-2002
Practice Address - Street 1:900 SKOKIE BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4012
Practice Address - Country:US
Practice Address - Phone:847-497-2020
Practice Address - Fax:847-497-2002
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-092731207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1600854OtherBCBS OF IL GROUP #
IL1600854OtherBCBS OF IL GROUP #
IL282190Medicare ID - Type Unspecified
ILP00817273Medicare PIN
ILIL2998001Medicare PIN