Provider Demographics
NPI:1861412702
Name:TAMID MEDICAL GROUP
Entity type:Organization
Organization Name:TAMID MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-282-6188
Mailing Address - Street 1:6936 N KOSTNER AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-4717
Mailing Address - Country:US
Mailing Address - Phone:773-282-6188
Mailing Address - Fax:773-282-7389
Practice Address - Street 1:6936 N KOSTNER AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-4717
Practice Address - Country:US
Practice Address - Phone:773-282-6188
Practice Address - Fax:773-282-7389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042005666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL734932Medicare ID - Type UnspecifiedPROVIDER NUMBER