Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 12646 | MT |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 4301085685 | MI |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD48950 | IA |
NPI | 1134345580 |
---|---|
Provider Name | Giselle Joan Tan |
First Address | West Burlington, IA 52655-1679 |
Second Address | West Burlington, IA 52655-1643 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 02/11/2021 |