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Individual

MRS. TAMARA L. OLT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
6915 N KNOXVILLE AVE, PEORIA, IL 61614-2850
(309) 692-2805
(309) 692-1913
Mailing address
6915 N KNOXVILLE AVE STE 1, PEORIA, IL 61614-2851
(309) 692-2805
(309) 692-1913

Taxonomy

Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
036089480
IL
207VX0000X
Obstetrics Physician
036089480
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036089480
IL
01
07232119
BCBS OF ILLINOIS
IL
01
343117
HEALTHLINK
IL
01
IL0101
JOHN DEERE HEALTH
IL
01
P00289284/DE3835
RAILROAD MEDICARE
IL
Enumeration date
05/19/2006
Last updated
03/06/2026
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