Individual
TANIA FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4820 W ARTHINGTON ST, CHICAGO, IL 60644-5205
(619) 818-1005
Mailing address
4820 W ARTHINGTON ST, CHICAGO, IL 60644-5205
(619) 818-1005
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
BC21500480
IN
Other
Enumeration date
01/24/2021
Last updated
01/24/2021
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