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Individual

DR. TANYA M POWELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1700 LUTHER LN, PARK RIDGE, IL 60068-1270
(630) 205-6612
(847) 698-0601
Mailing address
700 COMMERCE DR, SUITE 500, OAK BROOK, IL 60523-1546
(847) 698-0600
(847) 698-0601

Taxonomy

Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
036111022
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036111022
IL
01
558620
MEDICARE PROVIDER NUMBER
IL
01
778401
MEDICARE PROVIDER NUMBER
IL
01
P00138138
RAILROAD MEDICARE
IL
Enumeration date
10/31/2005
Last updated
12/27/2021
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