Fountain, Tamara R
Fountain, Tamara R is an individual health care provider with primary practice located at 740 Waukegan Rd Suite 360, Deerfield IL 60015-4374. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Ophthalmology, Allopathic & Osteopathic Physicians / Ophthalmic Plastic and Reconstructive Surgery. Allopathic & Osteopathic Physicians / Ophthalmic Plastic and Reconstructive Surgery is her primary health care specialty. Fountain, Tamara R can be contacted via phone (847) 945-6770.Contact Information
Primary practice address
740 Waukegan Rd Suite 360
Deerfield IL 60015-4374
Phone: (847) 945-6770
Fax: (847) 945-3159
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 036-085597 | Illinois |
| Allopathic & Osteopathic Physicians / Ophthalmic Plastic and Reconstructive Surgery | 207WX0200X | 036085597 | Illinois |
Profile Details
| NPI number | 1033110978 |
|---|---|
| LBN Legal business name | Fountain, Tamara R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 2nd, 2005 |
| Last updated | Jun 3rd, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1033110978 | NPPES |
| Illinois | MEDICAID | 036085597 | |
| Illinois | Other | 180042658 |
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