| Doctor Name: | DR. TAMAJAH MARIE GIBSON |
| NPI Number: | 1093931198 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | A96062 |
| Business Practice Address: | 5359 W Fullerton Ave Chicago, IL - 606391450 |
| Business Phone Number: | 7738362795 |
| Business Fax Number: | |
| Mailing Address: | 3 Erie Ct Ste 4125, OAK PARK |
| State: | IL |
| Postal Code: | 603022519 |
| Phone Number: | 7084063913 |
| Fax Number: | |
| NPI Enumeration Date: | 04/17/2007 |
| NPI Last Update Date: | 09/12/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A96062 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |