MEDICARE: KATHRYN E TANNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	2001006985	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518919265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN E TANNER MD

Provider Business Mailing Address
First Line	:	3 TEALWOOD CV
Second Line	:
City	:	CHARLESTON
State	:	IL
Zip	:	61920-4407
Country	:	US
Telephone Number	:	956-357-4082
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 HEALTH CENTER DR
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-4644
Country	:	US
Telephone Number	:	661-334-0203
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	03/07/2023

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Directions to “ KATHRYN E TANNER MD” Practice Location

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