Individual
DR. TARA GIBBONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 327-9124
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 327-9124
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
125.077557
IL
390200000X
Student in an Organized Health Care Education/Training Program
125.077557
IL
Other
Enumeration date
04/20/2021
Last updated
07/31/2021
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