Healthcare Provider Details

I. General information

NPI: 1972612760
Provider Name (Legal Business Name): TATIANA A BATISTA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 05/19/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5346 N CLARK ST
CHICAGO IL
60640-2120
US

IV. Provider business mailing address

1656 N WELLS
CHICAGO IL
60614
US

V. Phone/Fax

Practice location:
  • Phone: 773-293-8880
  • Fax: 773-293-8843
Mailing address:
  • Phone: 312-643-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036113050
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: