Healthcare Provider Details

I. General information

NPI: 1518131853
Provider Name (Legal Business Name): CHAN SENG TAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BENEDICT TAN M.D

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 CHERRY ST
TOLEDO OH
43608
US

IV. Provider business mailing address

2200 JEFFERSON AVE FL 5
TOLEDO OH
43604-7102
US

V. Phone/Fax

Practice location:
  • Phone: 419-251-8019
  • Fax: 419-251-5819
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberE-9895
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35134316
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberE-9895
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: