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General NPI Number Information
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NPI Number | 1225112196
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Entity Type | Individual
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Provider Name | BENJAMIN B TANG M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 333 W 89TH AVE STE W2
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City | MERRILLVILLE
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State | IN
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Zip | 46410
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Country | US
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Telephone | 317-671-7460
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Fax | 224-235-4652
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Provider Business Mailing Address
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Address Line | PO BOX 451
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City | NORTHBROOK
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State | IL
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Zip | 60065-0451
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Country | US
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Telephone | 847-593-8460
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Fax | 224-235-4652
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 036055168
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 01033529A
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License Number State | IN
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