Provider Demographics
NPI:1427106921
Name:REEVES RICHARDSON, TANYA (MD)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:REEVES RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:9550 W 167TH ST STE 200
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5561
Practice Address - Country:US
Practice Address - Phone:708-873-4500
Practice Address - Fax:708-873-4530
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN61570207Q00000X
ND14428207Q00000X
UT9770841-1205207Q00000X
TXR2210207Q00000X
IAMD-43788207Q00000X
OK32079207Q00000X
MO2016035067207Q00000X
KS04-38936207Q00000X
MS24673207Q00000X
IN01052656A207Q00000X
SD9899207Q00000X
NE29225207Q00000X
ALMD.35203207Q00000X
LA302964207Q00000X
IL036100994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100994Medicaid
ILH25221Medicare UPIN
IL036100994Medicaid