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Individual

JOHN U. TAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1473 E STATE ROAD 44, SUITE 3, CONNERSVILLE, IN 47331-8374
(765) 825-2229
Mailing address
1100 REID PKWY, MEDICAL STAFF SERVICES, RICHMOND, IN 47374-1157
(765) 825-2229
(765) 825-9767

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01042239A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000705820
ANTHEM
IN
05
200129020
IN
Enumeration date
01/20/2006
Last updated
05/18/2021
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