Healthcare Provider Details

I. General information

NPI: 1770518573
Provider Name (Legal Business Name): MIGUEL TAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW 77 BLDG 5TH FLOOR
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

1968 PEACHTREE RD NW 77 BLDG 5TH FLOOR
ATLANTA GA
30309-1281
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-4929
  • Fax:
Mailing address:
  • Phone: 404-605-4929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number060198
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: