Individual
EVELINE FAITH TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
2001 S WIESBROOK RD, WHEATON, IL 60189
(630) 614-4000
(630) 614-4048
Mailing address
2001 S WIESBROOK RD, WHEATON, IL 60189-7813
(630) 614-4000
(630) 614-4048
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016004847
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
592050
MEDICARE PTAN (GROUP)
IL
01
—
K37096
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
P00448606
RR MEDICARE
IL
Enumeration date
06/23/2005
Last updated
06/29/2018
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