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NPI Code Detail

MEDICARE: DR. TISHA MARIE BORROMEO SUBOC M.D.

MEDICARE: DR. TISHA MARIE BORROMEO SUBOC 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
1207RC0000XCardiovascular Disease Physician036-139517IL
2207RA0001XAdvanced Heart Failure and Transplant Cardiology Physician036-135917IL

General Provider Information

NPI Number : 1871736413
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TISHA MARIE BORROMEO SUBOC M.D.
Provider Business Mailing Address
First Line : 1725 W. HARRISON ST.
Second Line : SUITE 1159
City : CHICAGO
State : IL
Zip : 60612
Country : US
Telephone Number : 312-942-5020
Fax Number :
Provider Business Practice Location Address
First Line : 1725 W HARRISON ST STE 1159
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3883
Country : US
Telephone Number : 312-942-5020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2009
Last Update Date : 04/30/2021

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