Healthcare Provider Details

I. General information

NPI: 1376702340
Provider Name (Legal Business Name): SAN H TSAI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5490 BROADWAY
MERRILLVILLE IN
46410-1675
US

IV. Provider business mailing address

5490 BROADWAY
MERRILLVILLE IN
46410-1675
US

V. Phone/Fax

Practice location:
  • Phone: 219-884-2500
  • Fax:
Mailing address:
  • Phone: 219-884-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01026970A
License Number StateIN

VIII. Authorized Official

Name: SAN H TSAI
Title or Position: PRESIDENT
Credential: MD
Phone: 219-884-2500