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NPI Code Detail

MEDICARE: DR. PATRICIA TIERNAN M.D.

MEDICARE: DR. PATRICIA TIERNAN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician036079090IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447214614
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PATRICIA TIERNAN M.D.
Provider Business Mailing Address
First Line : 333 DIXIE HWY
Second Line :
City : CHICAGO HTS
State : IL
Zip : 60411-1748
Country : US
Telephone Number : 708-756-0100
Fax Number : 708-709-6353
Provider Business Practice Location Address
First Line : 333 DIXIE HWY
Second Line :
City : CHICAGO HTS
State : IL
Zip : 60411-1748
Country : US
Telephone Number : 708-756-0100
Fax Number : 708-709-6353
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2006
Last Update Date : 12/28/2011

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