Healthcare Provider Details

I. General information

NPI: 1760473144
Provider Name (Legal Business Name): ALEXANDRU BOGDAN TANASE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 GOSHEN RD
FORT WAYNE IN
46808-1493
US

IV. Provider business mailing address

2621 E JEFFERSON ST
WARSAW IN
46580-3880
US

V. Phone/Fax

Practice location:
  • Phone: 260-471-3500
  • Fax: 260-471-4263
Mailing address:
  • Phone: 574-267-7169
  • Fax: 574-269-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28566
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01080135A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: