Healthcare Provider Details

I. General information

NPI: 1134126683
Provider Name (Legal Business Name): ANNIE R TAN M..D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33100 CLEVELAND CLINIC BLVD
AVON OH
44011-1390
US

IV. Provider business mailing address

33100 CLEVELAND CLINIC BLVD
AVON OH
44011-1390
US

V. Phone/Fax

Practice location:
  • Phone: 440-695-4000
  • Fax:
Mailing address:
  • Phone: 440-695-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.091239
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: