Individual
ERNESTO TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 READ ST STE A, LOCKPORT, IL 60441-3265
(815) 741-1020
(815) 741-1064
Mailing address
10400 SOUTHWEST HWY LOWR LEVEL, CHICAGO RIDGE, IL 60415-2394
(708) 590-8770
(708) 428-4277
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036049705
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1467471540
GROUP NPI
—
01
—
DF2482
RR PTAM
—
01
—
IL3265
GROUP MEDICARE PTAN
—
Enumeration date
08/23/2006
Last updated
08/30/2023
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