Healthcare Provider Details

I. General information

NPI: 1356620371
Provider Name (Legal Business Name): GILBERT SIU FAI TANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 NORTH ST. CLAIR NORTHWESTERN MEMORIAL HOSPITAL, DEPT OF ANESTHESIOLOGY
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

676 NORTH ST. CLAIR NORTHWESTERN MEMORIAL HOSPITAL, DEPT OF ANESTHESIOLOGY
CHICAGO IL
60611-2908
US

V. Phone/Fax

Practice location:
  • Phone: 312-933-2783
  • Fax:
Mailing address:
  • Phone: 312-933-2783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036.138308
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: