Provider Demographics
NPI:1528822632
Name:BARATLI, TAMERLAN
Entity type:Individual
Prefix:
First Name:TAMERLAN
Middle Name:
Last Name:BARATLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6033 N SHERIDAN RD APT 39E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3034
Mailing Address - Country:US
Mailing Address - Phone:872-706-6000
Mailing Address - Fax:224-347-1145
Practice Address - Street 1:6033 N SHERIDAN RD APT 39E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-3034
Practice Address - Country:US
Practice Address - Phone:872-706-6000
Practice Address - Fax:224-347-1145
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver