Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 036089680 | IL |
NPI | 1407815277 |
---|---|
Provider Name | Dr. Tina Quanbee Tan |
First Address | Chicago, IL 60611-2605 |
Second Address | Chicago, IL 60611-2605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 24/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036089680 | (05) | IL |
F94014 | (02) |