Healthcare Provider Details

I. General information

NPI: 1528069895
Provider Name (Legal Business Name): CARI ANNE TARNOWSKI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 N CLARK ST SUITE 400
CHICAGO IL
60610-5467
US

IV. Provider business mailing address

PO BOX 189
MATTESON IL
60443-0189
US

V. Phone/Fax

Practice location:
  • Phone: 312-943-6964
  • Fax: 312-943-6924
Mailing address:
  • Phone: 708-747-5850
  • Fax: 708-747-9991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number036113566
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: