Individual
TAMARA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
469 W HURON ST, APT 810, CHICAGO, IL 60654-3467
(615) 423-9253
Mailing address
469 W HURON ST APT 810, CHICAGO, IL 60654-3457
(615) 423-9253
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
336086917
IL
2085R0202X
Diagnostic Radiology Physician
MD61483697
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/04/2007
Last updated
12/04/2025
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