Individual
SIDHARTHA TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3901 BEAUBIEN, CHILDREN'S HOSPITAL OF MI, DETROIT, MI 48201
(313) 745-4405
(313) 966-0665
Mailing address
4201 ST. ANTOINE - UHC 5D - #226, UNIVERSITY PEDIATRICIANS, DETROIT, MI 48201-2153
(313) 745-4405
(313) 966-0665
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301109000
MI
2080N0001X
Neonatal-Perinatal Medicine Physician
036068889
IL
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
4301109000
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036068889
STATE LICENSE
IL
01
—
4301109000
STATE LICENSE
MI
Enumeration date
12/08/2006
Last updated
03/01/2016
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