Healthcare Provider Details

I. General information

NPI: 1093977530
Provider Name (Legal Business Name): TAMAYO KAWAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SUPERIOR ST STE 101
MELROSE PARK IL
60160-4100
US

IV. Provider business mailing address

1111 SUPERIOR ST STE 101
MELROSE PARK IL
60160-4100
US

V. Phone/Fax

Practice location:
  • Phone: 708-406-3040
  • Fax:
Mailing address:
  • Phone: 708-406-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036127334
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number036127334
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: