Healthcare Provider Details

I. General information

NPI: 1629025663
Provider Name (Legal Business Name): TAMIR Y HERSONSKEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MADISON ST STE 300
JOLIET IL
60435
US

IV. Provider business mailing address

1000 REMINGTON BLVD STE 100
BOLINGBROOK IL
60440-4707
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-4367
  • Fax: 815-725-4863
Mailing address:
  • Phone:
  • Fax: 630-914-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number036-111695
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: