Provider Demographics
NPI:1093751091
Name:TANN, STEPHEN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:TANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4390
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-4390
Mailing Address - Country:US
Mailing Address - Phone:775-445-7650
Mailing Address - Fax:775-882-4206
Practice Address - Street 1:1470 MEDICAL PARKWAY
Practice Address - Street 2:SUITE 160
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4636
Practice Address - Country:US
Practice Address - Phone:775-445-7650
Practice Address - Fax:775-882-4206
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11880207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC4954OtherBLUE CROSS BLUE SHIELD
NV100510311Medicaid
NVP00371978Medicare PIN
NV100510311Medicaid
NVV102441Medicare PIN