Healthcare Provider Details

I. General information

NPI: 1659342665
Provider Name (Legal Business Name): ALBERT C TANLIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 S 4TH ST ROBERTS CLINIC LTD
WATSEKA IL
60970-1628
US

IV. Provider business mailing address

819 W LAFAYETTE ST #93
WATSEKA IL
60970
US

V. Phone/Fax

Practice location:
  • Phone: 815-432-2461
  • Fax: 815-432-2535
Mailing address:
  • Phone: 815-432-4743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number036091262
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: