1013171453 NPI number — DR. TAMI C CARRILLO MD

Table of content: DR. TAMI C CARRILLO MD (NPI 1013171453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013171453 NPI number — DR. TAMI C CARRILLO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARRILLO
Provider First Name:
TAMI
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCHUGH
Provider Other First Name:
TAMI
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013171453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CANCER TREATMENT CENTERS OF AMERICA
Provider Second Line Business Mailing Address:
2361 PAYSPHERE CIRCLE
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-322-9183
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CANCER TREATMENT CENTERS OF AMERICA
Provider Second Line Business Practice Location Address:
2520 ELISHA AVE
Provider Business Practice Location Address City Name:
ZION
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-322-9183
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X , with the licence number:  60905 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 036.120456 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)