Healthcare Provider Details

I. General information

NPI: 1891766499
Provider Name (Legal Business Name): BRADFORD TAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 01/22/2024
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 ELISHA AVE
ZION IL
60099-2676
US

IV. Provider business mailing address

2520 ELISHA AVE
ZION IL
60099-2676
US

V. Phone/Fax

Practice location:
  • Phone: 847-872-4888
  • Fax:
Mailing address:
  • Phone: 847-872-4561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036081859
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number036081859
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: