Individual
ELY ROBERT TANDETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2837 N MILWAUKEE AVE, CHICAGO, IL 60618-7403
(773) 235-6266
Mailing address
2837 N MILWAUKEE AVE, CHICAGO, IL 60618-7403
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036063792
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036063792
—
IL
Enumeration date
05/23/2006
Last updated
07/26/2013
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