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Individual

TIFFANY J FAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1115 RONALD REAGAN PKWY STE 266, AVON, IN 46123-6911
(317) 217-2500
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01085447A
IN
207V00000X
Obstetrics & Gynecology Physician
MT2013186
PA

Other

Enumeration date
05/12/2017
Last updated
08/04/2021
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