MEDICARE: DONALD TANIS 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	207RC0000X	Cardiovascular Disease Physician	036-083772	IL
2	207RA0002X	Adult Congenital Heart Disease Physician	036083772	IL

General Provider Information

NPI Number	:	1902822158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD TANIS M.D.

Provider Business Mailing Address
First Line	:	1725 W HARRISON ST
Second Line	:	SUITE 1159
City	:	CHICAGO
State	:	IL
Zip	:	60612-3841
Country	:	US
Telephone Number	:	312-942-5020
Fax Number	:	312-942-4039

Provider Business Practice Location Address
First Line	:	1725 W HARRISON ST
Second Line	:	SUITE 1159
City	:	CHICAGO
State	:	IL
Zip	:	60612-3841
Country	:	US
Telephone Number	:	312-942-5020
Fax Number	:	312-942-4039

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	04/22/2026

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