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:
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Health care specialties

SpecialtyCodeLicense #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 9 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033110978 NPPES
Illinois MEDICAID 036085597
Illinois Other 180042658

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