Individual
TAMIKA BURRUSSI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DN
Contact information
Practice address
356 W SUPERIOR ST FL 2, CHICAGO, IL 60654-3416
(312) 932-0300
(312) 932-0304
Mailing address
PO BOX 187, TINLEY PARK, IL 60477-0187
(708) 479-6522
(708) 479-6597
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
181.000359
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181.000359
—
IL
Enumeration date
08/12/2009
Last updated
08/12/2009
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