Individual
MARK TANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
714 N SENATE AVE, SUITE 250, INDIANAPOLIS, IN 46202-3763
(317) 715-6402
(317) 715-6415
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207UN0902X
Nuclear Imaging & Therapy Physician
01056509A
IN
2085N0904X
Nuclear Radiology Physician
Primary
01056509A
IN
2085R0202X
Diagnostic Radiology Physician
01056509A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200406300
—
IN
01
—
P00108643
RAIL ROAD MEDICARE
IN
01
—
P00195774
RAILROAD MEDICARE
IN
Enumeration date
06/06/2006
Last updated
03/05/2021
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