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General NPI Number Information
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NPI Number | 1659342665
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Entity Type | Individual
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Provider Name | ALBERT C TANLIM MD
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Gender | Male
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Dates
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Enumeration Date | 01/28/2006
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 845 S 4TH ST ROBERTS CLINIC LTD
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City | WATSEKA
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State | IL
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Zip | 60970-1628
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Country | US
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Telephone | 815-432-2461
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Fax | 815-432-2535
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Provider Business Mailing Address
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Address Line | 819 W LAFAYETTE ST #93
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City | WATSEKA
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State | IL
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Zip | 60970
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Country | US
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Telephone | 815-432-4743
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Fax |
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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 | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 036091262
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License Number State | IL
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