Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 060198 | GA |
NPI | 1770518573 |
---|---|
Provider Name | Miguel Tan |
First Address | Atlanta, GA 30309-1281 |
Second Address | Atlanta, GA 30309-1281 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 28/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
023084170A | (05) | GA |
I42728 | UPIN (01) |