Healthcare Provider Details

I. General information

NPI: 1992964191
Provider Name (Legal Business Name): TONI MARIE BISKUP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 S WOOD ST DEPARTMENT OF EMERGENCY MEDICINE
CHICAGO IL
60612-7300
US

IV. Provider business mailing address

808 S WOOD ST DEPARTMENT OF EMERGENCY MEDICINE
CHICAGO IL
60612-7300
US

V. Phone/Fax

Practice location:
  • Phone: 312-355-0865
  • Fax:
Mailing address:
  • Phone: 312-355-0865
  • Fax: 312-413-0289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036130173
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036130173
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: