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Individual

DR. BENJAMIN B TANG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
333 W 89TH AVE STE W2, MERRILLVILLE, IN 46410
(317) 671-7460
(224) 235-4652
Mailing address
PO BOX 451, NORTHBROOK, IL 60065-0451
(847) 593-8460
(224) 235-4652

Taxonomy

Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
01033529A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
036055168
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000077842
ANTHEM BCBS IN
IN
05
100203000A
IN
01
330002905
RAILROAD MEDICARE PART B
01
351859903
ILLINOIS PULIC AID
IL
01
351859903012
BLUE SHIELD WI
WI
01
911-08127
BLUE SHIELD IL
IL
Enumeration date
10/25/2006
Last updated
12/06/2018
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