Individual
CHUNG NING TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7230 ENGLE RD, FORT WAYNE, IN 46804
(260) 234-5400
(260) 234-5410
Mailing address
1200 W WHITE RIVER BLVD, PROVIDER ENROLLMENT DEPARTMENT, MUNCIE, IN 47303-4988
(260) 234-5400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01077240A
IN
207Q00000X
Family Medicine Physician
11018187
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001176909
ANTHEM BCBS
IN
05
—
201297950
—
IN
Enumeration date
06/04/2015
Last updated
10/07/2022
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