MEDICARE: TAMARA MARJAN DMD

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
1	122300000X	Dentist	019.031700	IL

General Provider Information

NPI Number	:	1841783651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA MARJAN DMD

Provider Business Mailing Address
First Line	:	340 E RANDOLPH ST UNIT 205
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-7418
Country	:	US
Telephone Number	:	936-239-0753
Fax Number	:

Provider Business Practice Location Address
First Line	:	15909 HARLEM AVE
Second Line	:
City	:	TINLEY PARK
State	:	IL
Zip	:	60477-1609
Country	:	US
Telephone Number	:	708-429-0915
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2018
Last Update Date	:	06/07/2018

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