Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | IL |
NPI | 1003801226 |
---|---|
Provider Name | Dr. Galo Lim Tan |
First Address | Gurnee, IL 60031-3393 |
Second Address | Gurnee, IL 60031-3393 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4900521 | BLUE CROSS (01) | IL |
C44601 | (02) |