MEDICARE: DR. TIMOTHY TAN M.D

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	207Q00000X	Family Medicine Physician		IL

General Provider Information

NPI Number	:	1851348783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY TAN M.D

Provider Business Mailing Address
First Line	:	766 CAMELOT DR
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-6250
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4947 N WINTHROP AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3607
Country	:	US
Telephone Number	:	773-989-9118
Fax Number	:

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	07/08/2007

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