Individual
JONATHAN TAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
A125923
CA
208000000X
Pediatrics Physician
125-052818
IL
208000000X
Pediatrics Physician
54495
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125-052818
ILLINOIS LICENSE
IL
Enumeration date
07/30/2008
Last updated
06/17/2015
Update your record
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