Healthcare Provider Details

I. General information

NPI: 1740436229
Provider Name (Legal Business Name): TINA TAUBE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TINA MATHAI M.D.

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 W WELLINGTON AVE 3604
CHICAGO IL
60657-5147
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 314-799-5025
  • Fax:
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.054721
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberDR.0065838
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036.127791
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: