Healthcare Provider Details

I. General information

NPI: 1407815277
Provider Name (Legal Business Name): TINA QUANBEE TAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 EAST CHICAGO AVE BOX #20
CHICAGO IL
60611-2605
US

IV. Provider business mailing address

225 EAST CHICAGO AVE BOX #20
CHICAGO IL
60611-2605
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4000
  • Fax: 312-227-9709
Mailing address:
  • Phone: 312-227-4000
  • Fax: 312-227-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number036089680
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: