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NPI Code Detail

MEDICARE: TABITHA A WATTS M.D.

MEDICARE: TABITHA A WATTS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician137-320WI
2208000000XPediatrics Physician036-108494IL
32080P0204XPediatric Emergency Medicine (Pediatrics) Physician036-108494IL
4208M00000XHospitalist Physician01092245AIN
5208000000XPediatrics Physician01092245AIN

General Provider Information

NPI Number : 1750469987
Entity Type Code : Individual
Provider Name (Legal Business Name) : TABITHA A WATTS M.D.
Provider Business Mailing Address
First Line : PO BOX 4645
Second Line :
City : CHICAGO
State : IL
Zip : 60680-4645
Country : US
Telephone Number : 312-451-5695
Fax Number : 312-264-0662
Provider Business Practice Location Address
First Line : 1449 S MICHIGAN AVE # 1307
Second Line :
City : CHICAGO
State : IL
Zip : 60605-2810
Country : US
Telephone Number : 888-437-2682
Fax Number : 312-264-0662
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2006
Last Update Date : 04/16/2026

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