Individual
NIKKI BORAH TANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
21660 W FIELD PKWY, DEER PARK, IL 60010-7265
(888) 803-3370
Mailing address
21660 W FIELD PKWY, DEER PARK, IL 60010-7265
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085006035
IL
363A00000X
Physician Assistant
14155593-1206
UT
363A00000X
Physician Assistant
PA61936
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
920540
MEDICARE GROUP
IL
01
—
F400460219
MEDICARE INDIVIDUAL
IL
Enumeration date
10/07/2016
Last updated
12/27/2024
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