Basic Information
| Provider Information | |||||||||
| NPI: | 1922625672 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONTGOMERY NEE BROWN | ||||||||
| FirstName: | TANYA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 W POLK ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606123723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3128640393 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1950 WEST POLK STREET, | ||||||||
| Address2: | NEONATAL AND PERINATAL DEPARTMENT | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3128644044 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2020 | ||||||||
| LastUpdateDate: | 06/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 125.076792 | IL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.