Individual
DR. JOHN CHRISTOPHER FORMOSO TANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
13100 E 136TH ST STE 3600, FISHERS, IN 46037-9822
(317) 944-0980
(317) 944-1497
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5101015998
MI
207RG0100X
Gastroenterology Physician
Primary
02003779A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201012180
—
IN
01
—
M400039154
MEDICARE PTAN
IN
Enumeration date
05/18/2007
Last updated
03/13/2025
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