1699063222 NPI number — MRS. TARA THANANETAPON ALAICHAMY D.P.T.

Table of content: MRS. TARA THANANETAPON ALAICHAMY D.P.T. (NPI 1699063222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699063222 NPI number — MRS. TARA THANANETAPON ALAICHAMY D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALAICHAMY
Provider First Name:
TARA
Provider Middle Name:
THANANETAPON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THANANETAPON
Provider Other First Name:
TARA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699063222
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2610 SHERIDAN ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZION
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-884-7346
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2520 ELISHA AVENUE
Provider Second Line Business Practice Location Address:
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:
847-731-1605
Provider Business Practice Location Address Fax Number:
847-872-6176
Provider Enumeration Date:
07/18/2011

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: 225100000X , with the licence number:  P12259 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com