Individual
TISHA JOERLA MIRASOL TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
442 N IL ROUTE 31, CRYSTAL LAKE, IL 60012-3709
(224) 238-3211
(224) 535-8215
Mailing address
PO BOX 3877, JOLIET, IL 60434-3877
(815) 741-6830
(815) 741-6832
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
036137011
IL
Other
Enumeration date
07/06/2012
Last updated
09/15/2022
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