# BERMING PAN MD INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649453226
- **Authorized official:** CHEN-TSU PAN MD (MEDICAL DOCTOR)
- **Authorized official phone:** (702) 486-4255

## Contact information

- **Practice address:** 306 OHIO ST, WANATAH, IN 46390-0367
- **Practice address phone:** (219) 733-2755
- **Practice address fax:** (219) 733-2377
- **Mailing address:** PO BOX 367, WANATAH, IN 46390-0367
- **Mailing address phone:** (219) 733-2755
- **Mailing address fax:** (219) 733-2755

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/06/2007
- **Last updated:** 01/07/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000084157 | BCBS | IN |
| 05 | — | 100163680A | — | IN |