MEDICARE: DR. ALESSANDRA MARINELLA TACHAUER MD

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
1	2084P0800X	Psychiatry Physician	036090391	IL

General Provider Information

NPI Number	:	1508139262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALESSANDRA MARINELLA TACHAUER MD

Provider Business Mailing Address
First Line	:	1901 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3714
Country	:	US
Telephone Number	:	312-864-6072
Fax Number	:	312-864-9011

Provider Business Practice Location Address
First Line	:	1901 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-6034
Country	:	US
Telephone Number	:	312-864-6072
Fax Number	:	312-864-9011

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2012
Last Update Date	:	04/30/2021

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