Organization
FAYETTE COUNTY PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN TAN MD (OWNER)
(765) 825-4949
Entity
Organization
Contact information
Practice address
2025 VIRGINIA AVE, CONNERSVILLE, IN 47331-2921
(765) 825-4949
Mailing address
PO BOX 779, CONNERSVILLE, IN 47331-0779
(765) 827-1903
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
01/20/2006
Last updated
08/22/2020
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