Individual
TIFFANY TAHATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1725 W HARRISON ST, CHICAGO, IL 60612-3841
(312) 942-5000
Mailing address
345 E WACKER DR APT 701, CHICAGO, IL 60601-5289
(808) 225-1989
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
036165203
IL
Other
Enumeration date
04/25/2020
Last updated
06/25/2024
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