Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 01032934 | IN |
NPI | 1013985258 |
---|---|
Provider Name | Virginia Tan Tabib |
First Address | Valparaiso, IN 46383-0970 |
Second Address | Merrillville, IN 46410-6158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 15/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100208820 | (05) | IN |
5171410004 | DMERC (01) | IN |
B29264 | (02) |