MEDICARE: DR. SUMEET SINGH-TAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	125067514	IL

General Provider Information

NPI Number	:	1215318001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUMEET SINGH-TAN D.O.

Provider Business Mailing Address
First Line	:	1900 W POLK ST
Second Line	:	STE 912
City	:	CHICAGO
State	:	IL
Zip	:	60612-3723
Country	:	US
Telephone Number	:	312-864-4461
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 COLUMBUS PL APT S22G
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-8207
Country	:	US
Telephone Number	:	209-610-3809
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2015
Last Update Date	:	10/23/2018

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