Provider Demographics
NPI:1306825740
Name:TROY, TARA N (MD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:N
Last Name:TROY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 TECHNOLOGY WAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5366
Mailing Address - Country:US
Mailing Address - Phone:224-407-4400
Mailing Address - Fax:224-407-2255
Practice Address - Street 1:40 SKOKIE BLVD.
Practice Address - Street 2:SUITE 110
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1614
Practice Address - Country:US
Practice Address - Phone:224-407-4400
Practice Address - Fax:224-407-2255
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108334174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108334OtherSTATE LICENSE