Individual
CORINNE TAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(314) 268-4180
Mailing address
1465S. GRAND BOULEVARD, GLENNON HALL 5727, SAINT LOUIS, MO 63104
(314) 268-4180
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
2020036060
MO
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
2020036060
MO
Other
Enumeration date
06/11/2009
Last updated
03/22/2021
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