Olt, Tamara L.
Olt, Tamara L. is an sole proprietor health care provider with primary practice located at 5401 N Knoxville Ave Suite 109, Peoria IL 61614-5098. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Gynecology, Allopathic & Osteopathic Physicians / Obstetrics. Allopathic & Osteopathic Physicians / Gynecology is her primary health care specialty. Olt, Tamara L. can be contacted via phone (309) 692-2805.Contact Information
Primary practice address
5401 N Knoxville Ave Suite 109
Peoria IL 61614-5098
Phone: (309) 692-2805
Fax: (309) 692-1913
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Gynecology | 207VG0400X | 036089480 | Illinois |
| Allopathic & Osteopathic Physicians / Obstetrics | 207VX0000X | 036089480 | Illinois |
Profile Details
| NPI number | 1104870708 |
|---|---|
| LBN Legal business name | Olt, Tamara L. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 19th, 2006 |
| Last updated | Dec 28th, 2011 - about 13 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 | 1104870708 | NPPES |
| Illinois | Other | 07232119 | BCBS OF ILLINOIS |
| Illinois | Other | P00289284/DE3835 | BCBS OF ILLINOIS |
| Illinois | MEDICAID | 036089480 | BCBS OF ILLINOIS |
| Illinois | Other | IL0101 | BCBS OF ILLINOIS |
| Illinois | Other | 343117 | BCBS OF ILLINOIS |
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