MEDICARE: MR. ROSS TANIS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	77163	WI

General Provider Information

NPI Number	:	1861951949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROSS TANIS

Provider Business Mailing Address
First Line	:	302 SAMUEL DR APT 131
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53717-2238
Country	:	US
Telephone Number	:	803-727-5117
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 SAMUEL DR APT 131
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53717-2238
Country	:	US
Telephone Number	:	803-727-5117
Fax Number	:

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

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	11/15/2024

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Directions to “ MR. ROSS TANIS ” Practice Location

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