Healthcare Provider Details

I. General information

NPI: 1700814183
Provider Name (Legal Business Name): RAUL CAYABYAH TAMAYO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3722 HARLEM AVE SUITE 200
RIVERSIDE IL
60546-2312
US

IV. Provider business mailing address

2368 PAYSPHERE CIR
CHICAGO IL
60674-0023
US

V. Phone/Fax

Practice location:
  • Phone: 708-447-4999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36088353
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: