Individual
DR. TARA ELIZABETH DOMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
636 RAYMOND DR, SUITE 205, NAPERVILLE, IL 60563-9789
(630) 717-2300
(630) 717-9638
Mailing address
636 RAYMOND DR, SUITE 205, NAPERVILLE, IL 60563-9789
(630) 717-2300
(630) 717-9638
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036121608
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036121608
—
IL
01
—
2215474
BCBS OF ILLINOIS
IL
Enumeration date
06/11/2007
Last updated
10/04/2018
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