Individual
DR. TAMARA R FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
740 WAUKEGAN RD, SUITE 360, DEERFIELD, IL 60015-4374
(847) 945-6770
(847) 945-3159
Mailing address
740 WAUKEGAN RD, SUITE 360, DEERFIELD, IL 60015-4374
(847) 945-6770
(847) 945-3159
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
036-085597
IL
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
036085597
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036085597
—
IL
01
—
180042658
RAILROAD MEDICARE
—
Enumeration date
08/02/2005
Last updated
06/03/2016
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