Individual
ANNIE TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11850 BLACKFOOT ST NW, SUITE 100, COON RAPIDS, MN 55433-2598
(763) 721-2100
(763) 721-2190
Mailing address
11850 BLACKFOOT ST NW, SUITE 100, COON RAPIDS, MN 55433-2598
(763) 721-2100
(763) 721-2190
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
47116
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07-05956
MEDICA
MN
01
—
132945
UCARE
MN
01
—
2368961
ARAZ
MN
01
—
815T5TA
BCBS
MN
01
—
83694-0
FAIRVIEW
MN
01
—
961141050294
PREFERREDONE
MN
01
—
HP53303
HEALTHPARTNERS
MN
Enumeration date
10/11/2006
Last updated
09/23/2015
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