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General NPI Number Information
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NPI Number | 1144425174
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Entity Type | Individual
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Provider Name | ALLISON RAE TANCK M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 7001 ROGERS AVE FL 6
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City | FORT SMITH
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State | AR
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Zip | 72903-4073
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Country | US
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Telephone | 479-314-4619
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Fax | 479-461-4078
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Provider Business Mailing Address
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Address Line | PO BOX 776084
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City | CHICAGO
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State | IL
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Zip | 60677-6084
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Country | US
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Telephone | 479-314-4619
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Fax | 479-461-4078
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036130952
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036130952
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | E-19587
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License Number State | AR
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