Individual
DR. ANGIE ROSANNE TARAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2350 RAVINE WAY, 400, GLENVIEW, IL 60025-7621
(312) 715-7552
Mailing address
2760 WYNFIELD LN, BROOKFIELD, WI 53045-3352
(312) 659-8005
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
55873-20
WI
208D00000X
General Practice Physician
55873-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201083390A
—
IN
Enumeration date
04/26/2007
Last updated
10/18/2019
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