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NPI Code Detail

MEDICARE: EDWARD J. TANOUS JR. MD

MEDICARE: EDWARD J. TANOUS JR. MD
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician25971KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528060043
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD J. TANOUS JR. MD
Provider Business Mailing Address
First Line : 3529 SOLUTIONS CENTER
Second Line :
City : CHICAGO
State : IL
Zip : 60677-3005
Country : US
Telephone Number : 800-288-8325
Fax Number : 419-866-5453
Provider Business Practice Location Address
First Line : 175 HOSPITAL DRIVE
Second Line :
City : WINCHESTER
State : KY
Zip : 40391-1169
Country : US
Telephone Number : 859-745-3500
Fax Number : 859-737-8350
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 09/25/2012

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