Individual
DR. ENRICO TAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
410 E STATE ST, ATHENS, OH 45701-1819
(740) 592-2366
(740) 594-2871
Mailing address
410 E STATE ST, ATHENS, OH 45701-1819
(740) 592-2366
(740) 594-2871
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
36002613
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000123607
ANTHEM BC/BS PROV NUMBER
OH
05
—
0765159
—
OH
01
—
0784560001
DMERC
OH
Enumeration date
07/20/2006
Last updated
02/14/2011
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